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Help finding Texas Providers of MH Services

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Help finding Texas Providers of MH Services

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eLearning Hub

This resource center is designed to equip you with knowledge, resources, and a sense of hope for the future - for yourself or someone else you care about.

Check out our eLearning Hub to learn more about common behavioral health conditions.

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Find Resources or a Provider | You're Not Alone | Mental Health Texas

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Mental Health Texas provides learning and treatment opportunities for those coping with mental health conditions and those who support them.

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NAMI: National Alliance on Mental Illness Central Texas

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NAMI: National Alliance on Mental Illness Central Texas

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Coronavirus and NAMI Central Texas

Like nearly everyone in the community, we at NAMI Central Texas are monitoring the Coronavirus situation. Based on the current public health recommendations, we plan to minimize the risk for volunteers and participants while continuing to provide mental health education, support, and resources to you as best we can. Please visit our Coronavirus page for program updates and resources.

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NAMI Central Texas - Providing education, support and advocacy for those affected by mental illness

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Like nearly everyone in the community, we at NAMI Central Texas are monitoring the Coronavirus situation. Based on the current public health recommendations, we plan to minimize the risk for volunteers and participants while continuing to provide mental health education, support, and resources to you as best we can.

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512-819-1154 Call us today for a free, confidential assessment.

STARS Values

Service

To serve our community is a privilege and an obligation...

Teamwork

Together, we do great things for those in need...

Respect

We are here to better the lives of others...

Standards

We pledge to our community, the highest standards of deference...

Mental Health & Psychiatric Hospital in Georgetown, TX
Welcome to Georgetown Behavioral Health Institute (GBHI). We are a state-of-the-art, 118-bed acute care psychiatric hospital offering comprehensive behavioral health services to adults, teens, children and seniors located in the Georgetown and Austin areas. Our inpatient acute care services and outpatient programs support patients through their discharge or as an effective alternative to hospitalization.

Our hospital provides person-centered treatment within a safe environment staffed by knowledgeable and empathetic professionals. Our staff works with each individual patient to promote stabilization and healing according to the patient's unique needs. Patients gain skills in the areas of developing healthy boundaries, learning how to appropriately express emotions, using effective communication skills, increasing self-esteem, managing anger, and developing life skills.

Call us today at 877-500-9151 or visit us on campus to learn more about our behavioral health programs, admissions process, and management staff. We're available 24 hours, 7 days a week to guide you through your personalized healing process.

Sincerely,
GBHI Staff

Contact Us

COVID-19 Update

Georgetown Behavioral Healthcare Institute has been monitoring the daily events surrounding the COVID-19 virus and complying with guidance from the CDC and our state and local public health departments. While we maintain our commitment to high quality and compassionate care, we are keenly aware that we must protect and maintain a safe treatment environment for our patients, family members, and staff. We are here to support and protect each other. As such, we have implemented the following procedures/restrictions.

Upon entering our building all, family members, vendors, and patients will be asked specific questions about their current healthcare status, including signs and symptoms of any upper respiratory conditions. This brief questionnaire may also include a temperature scan. Outpatient services will continue as normal, but patients will be queried about symptoms and may be scanned for temperature.

At this time In-person visitation is prohibited. Our virtual visitation hours are 10:00am - 7:00pm:

Adults (18+) - Tuesday and Thursday

Children (8-12) and Adolescents (13-17) - Monday/Wednesday/Friday/Saturday/Sunday

In order to schedule a patient visit via ZOOM, please call (512)639-1271 between 10:00am - 7:00pm.

All family therapy sessions will be held telephonically or virtually. In-house therapists/case managers will coordinate these appointments with family members.

All vendors will be asked to enter through the front entrance and screened for temperature. Vendor access will be limited and at the discretion of hospital management.

Georgetown Behavioral Healthcare strives to keep everyone who has entrusted their care to us in the safest environment possible. As information changes, we will update these procedures. We appreciate your understanding as we respond to these challenges and take utmost care for all of our patients.

Monica Ochoa, CEO
Georgetown Behavioral Health Institute.

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Mental Health Clinic & Psychiatric Hospital | Georgetown Behavioral Health Institute

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512-819-1154 Call us today for a free, confidential assessment. Service To serve our community is a privilege and an obligation... Teamwork Together, we do great things for those in need... Respect We are here to better the lives of others... Standards We pledge to our community, the highest standards of deference...

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Everyone has good times in life, and everyone has bad times. Difficulty, hardship, and challenges are normal parts of being human. People's Instagram accounts or Facebook profiles might seem picture-perfect, but the truth is that life is always more complicated. When challenges arise, everybody has two basic options for handling them:

1. Accept reality and make necessary adjustments.

2. Ignore reality and continue as usual.

The second option often tempts people because, in the short term, it is usually easier. Acknowledging difficult realities is painful, and making necessary adjustments is even more painful. It is understandable that many people want to continue with their lives as normal. This strategy, however, comes with a long-term catch. When people ignore their problems and do not address them, they may become stuck in the problem, and the problem may grow worse over time.

The first option may be harder in the short term, but in the long term, accepting reality and making adjustments can lead to countless benefits. And no one has to work through life's challenges alone. Counselors, life coaches, and therapists are available to offer support and guidance during life's most difficult trials.

The professionals at Thriveworks Counseling & Psychiatry Cedar Park understand that life is not always smooth sailing, and we also understand that a little support during hard times can make all the difference. That is why we are here-we love seeing our clients work through a challenge and thrive. And we can help them do this in in-person counseling or online therapy.

What Mental Health Services Are Offered at Thriveworks Counseling & Psychiatry Cedar Park?

Here's a list of the main mental health services offered at Thriveworks Counseling & Psychiatry Cedar Park:

Through counseling, therapy, and/or psychiatry services, we help with a range of mental health conditions and other challenges, including:

Our providers - from therapists/counselors to psychologists, psychiatrists, and nurse practitioners - specialize in a range of counseling approaches, but they'll cater your treatment to your unique preferences and needs. They might utilize:

What Could Life Look Like?

The good news is that therapy and counseling are not only about working through problems. In many ways, it is not about life's problems at all. The ultimate goal, actually, is proactively building a healthy, happy life.

What do you dream about for your life? Is there something you want to do or to try but have not because of fear? What could your life look like if these challenges were dealt with and not holding you back?

Therapy often begins with a person who needs help during a specific challenge or for a specific problem. But in the process, many people find improved overall mental health and well-being. In this respect, physical health and mental health are similar. When they care for their bodies by eating well, sleeping enough, and exercising, people regularly experience overall better physical health. A similar dynamic happens in mental health. By attending to their minds and emotions, people often experience overall improved mental health.

Attending to one's mental health may sound easy, but here is another correlation between physical health and mental health. Many people need a personal trainer, nutritionist, or doctor to help them maintain physical health. Many people also need a counselor, life coach, or therapist to help them achieve and maintain their mental health.

As their mental health improves, many clients at Thriveworks Counseling & Psychiatry Cedar Park have experienced...

Reduced anxiety

More self-esteem

A greater sense of life-purpose

Increased ability to focus on their life's goals

More sleep

Alleviated mental health disorders and their symptoms

Better interpersonal skills

Scheduling an Appointment at Thriveworks Counseling & Psychiatry Cedar Park

Has an unforeseen crisis knocked you off balance? Has a challenge grown and become unmanageable? Are you ready to stop reacting to life and start pursuing your dreams? You do not have to navigate these alone. Thriveworks Counseling & Psychiatry Cedar Park has appointments available.

When you reach out to our office for psychiatry, coaching, or therapy, know that we want to provide you with first-rate care from the moment you dial our number. A scheduling specialist will answer your call, and many first-time clients see their therapist the following day. We do not keep a waitlist, but we do work with many insurance providers.

If you are ready to begin building a better life, we are ready to help. Call Thriveworks Counseling & Psychiatry Cedar Park to get started with in-person counseling or online counseling therapy.

Where Is Thriveworks Counseling & Psychiatry Cedar Park Located?

Thriveworks Counseling & Psychiatry Cedar Park is located at 345 Cypress Creek Road #102, Cedar Park, TX 78613. We are in the same building as Orthopedic Associates of Central Texas. If you have trouble finding us, please give us a call - we're here to help, and we look forward to meeting you soon!

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Thriveworks Counseling & Psychiatry Cedar Park

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Everyone has good times in life, and everyone has bad times. Difficulty, hardship, and challenges are normal parts of being human. People's Instagram accounts or Facebook profiles might seem picture-perfect, but the truth is that life is always more complicated. When challenges arise, everybody has two basic options for handling them: Accept reality and make necessary adjustments.

# data[].attributes.attachment_link.readable_text
This page contains affiliate links, read the disclosure statement Inside: Kid tested strategies used by child therapists for calming anxiety, including ideas to calm down, books to read and videos that can help
It's happening again. Your daughter is frustrated and stomping away down to her room, slamming the door and in general "has her cranky pants on". You say calm down, but she yells back "I don't know how to do that!!!"

We tend to tell our kids to "calm down" without ever giving them explicit directions on how to deal with stress and anxiety. Here's a collection of the best tools and tips I've found to teach children how to calm down and relax.

Sometimes you'll need a quick way to help your child calm down and you don't have much with you. Maybe it's when you're out at Target or stuck in traffic. These tips will come in handy at those times:

Imagine your favorite place - it's like taking a mini vacation wherever you are

Think of your favorite things

Name animals alphabetically (alligator, bear, cow, dog, etc...)

Squeeze Something (play dough, clay, silly putty, your fists, a stress ball)

Get a Cold Drink of Water

54321 Grounding - go through each of your 5 senses

1. Put your arms straight out in front of you, palms facing out.

2. Put one hand over the other at the wrists and interlace your fingers.

3. Swoop your hands and arms toward your body and then place your interlaced hands on your chest.

4. Cross your feet at the ankles and put your tongue on the roof of your mouth.

5. Stay still for one minute.

It's great to have a big list of coping skills to try when your child needs to calm down. Here are two more short lists of ideas for calming down at home or at school.

From Imperfect Families - Strategies to use at home

From Encourage Play - 10 Strategies to Help Kids Calm Down at school or home

People usually roll their eyes initially when they hear "breathing is important". But I will continue to say it and explain why. It's so simple, yet has such a big impact on your body's physiology.

When you and calm and relaxed, your body is in "rest and digest" mode. You breathe normally, your heart rate is lower and your muscles are relaxed. However, when stress or anxiety or anger occurs, your body automatically switches into "flight, fight or freeze" mode. Your muscles tense up, your heart rate increases and your breathing becomes more shallow.

Taking deep breaths, instead of shallow breaths, is one way to tell your body to get back to resting and digesting. That's why deep breathing is important!

Luckily, there are some fun ways to teach kids deep breathing techniques

Things to use

Things to say

Breathe in like you are smelling a flower, breathe out like you are blowing out birthday candles

Arms up and breathe in, arms down and breathe out

Pretend your belly is a balloon. Breathe in and make the balloon bigger, then breathe out and make the balloon shrink.

Videos to watch
4 - 7 - 8 Breathing by GoZen
Breathing at Sea Otter Cove from Stress Free Kids

A Coping Skills Toolbox is a kit that you create to help your child calm down when they are upset, anxious or worried. In order to get the most benefit from this, you should create this kit before an issue occurs. When your child experiences anxiety, then they can pick out an item from their Coping Skills Toolbox. This is one of my favorite ways to help kids learn to calm their anxiety.

Here are some other fantastic ideas for what to put in a coping skills toolbox/calm down kit from And Next Comes L

You can create a place specially designed to allow to calm down in a few steps

Find a spot and make it cozy (ask your child for help with that - maybe they can place a favorite blanket or stuffed animal inside)

Add calming tools

Explain how to use it and practice before

When they are starting to escalate, catch it early and give them a calm reminder about their calm down spot

Use the following phrases as a way to support your child, let them know that you're going to support them and help them in any way that you can.

"I'm here for you"

"Talk to me and tell me what's going on"

"How can I help?"

"Together, we can work on this. We're a great team"

"I love you"

"Do you want a hug?"

Here are some more ideas of what to say to calm an anxious child.

From Go Zen - 49 Phrases to Calm an Anxious Child

From Lemon Lime Adventures - What to Say to Calm an Anxious Child

Did you know there are podcasts with stories for children? Usually the hosts have a soothing voice and the stories tend to be pretty short. Your child can listen to these podcasts as a way to have some down time.

There are scripts you can read to your child to help them relax and calm down. Slowly and carefully read the words as your child listens and follows the instructions. Check out Inner Health Studios list of scripts you can use with your child. If you prefer not to read a script, there are ones that are pre-recorded.

There are also scripts to practice mindfulness with children. Eline Snel has written a great book on Mindfulness with Kids, Sitting Still Like a Frog. Here are the several scripts that can be used from that book!

Annaka Harris also has several pre-recorded scripts to help kids practice mindfulness

Confused about how to introduce mindfulness to kids? Check out these resources:
Simple Ways to Introduce Mindfulness and Meditation to Children 11 Simple But Effective Ways to Teach Mindfulness to Kids
What you need:

I've used empty soda bottles, empty water bottles, glass jars and plastic containers. Use whatever makes sense for you and your family. For instance, for the calming jars the kids have in their room, I used a heavy duty plastic bottle. I didn't want them to accidentally knock over a glass jar in the dark - that would be a huge mess!

I've had the best results when I've used warm water - it makes it easier for the water and paint to combine.
Glitter Paint
I prefer using glitter paint (or glitter glue) instead of glitter because then I'm not cleaning up glitter for weeks at my house after we make them :-)

To make your jar, add glitter paint to the bottom of the jar until it just covers the bottom of it. Add warm water. Put the cover on and shake to help the ingredients combine. Once you are satisfied with the look of your jar, then you can super glue the lid shut so it doesn't spill. In a pinch, I've also used duct tape to secure the lid.
Watch Make a Simple Calming Jar from Coping Skills for Kids on YouTube Wet Ingredients
Sometimes you want the glitter/other items to stay afloat longer or for a shorter amount of time. Here are some different ingredients you can use as the wet ingredients.
Dry Ingredients
To see several other ways to make calming jars, take a look at what Preschool Inspirations did.

One of the first things I always like to do with kids if they are struggling is to start using visuals. When you're stressed and anxious, it's harder to read and take in information. Visuals are easier.

I like to keep calming cue cards in my children's coping skills toolboxes so that they can make a decision about what coping skill they can use. Sometimes pulling out a list is too much in the moment. You can make your own cue cards.

1. Take several index cards or small pieces of cardstock

2. On each one, write or draw one coping skill

3. Hole punch the cards and place them on a keyring (to make them extra sturdy, you can laminate them)

4. Put them into the coping skills toolbox for easy access

Using visuals is a powerful way to help kids. When kids are overwhelmed, sometimes it's hard for them to figure out what to do. By having cue cards, your child can have a visual reminder of what calms and relaxes them.

To make things a little easier, I've created ready to use coping skills cue cardsfor you. There are four different sets: Calming, Physical, Distracting, and Processing. If you'd like all 4, I created a set where you can download them all together.

If your child is anxious, they may also be having a difficult time getting settled for bedtime. Here are some ideas to help your child get settled at bedtime.

PINPOINT WHAT THE FEAR IS

One of the most important things to do is to figure out exactly what is causing the anxiety. Is it fear of the dark? Is it a worry about something in the closet? Is it monsters? Is it spiders? Figuring out the cause of the fear will help you come up with ways you can help your child combat it.

REARRANGE THE ROOM

Are there particular spots of the room that seem to be darker or cause more fear at night than others? Go into the bedroom during the day with your child and talk about the spots that make your child nervous. Try moving night lights and furniture around for a more calming room arrangement.

TRANSITIONAL OBJECTS

If your child has a hard time separating from you, try a transitional object. This is a special item that helps your child feel comforted. It helps them feel like part of you is still present even when you're not there. It could be something like a stuffed animal or a special stone or necklace, or a sweatshirt of yours. The object isn't what matters, it's what the object represents. They can keep it and hold it all night long to help them relax and go to sleep.

Find more strategies here: 12 Kid Friendly Strategies to Calm Anxiety at Night

Looking for some calming guided meditation to help get to sleep at night? Try one of these: Best Guided Meditations for Sleep.

Whenever I sit down and talk with someone about their coping skills, one of the first
things I ask is if they have tried writing about it. Why do I always start with journaling as
a way of processing through difficult feelings?

It's easier to write about than talk about hard things

Journaling helps you process what's happening.

It's convenient.

It's not graded

It can help you solve a problem

It can help you re-frame your thinking

Looking for a journal for a child or teen? Check out Big Life Journals!

General Anxiety

The Coping Skills for Kids Workbook by Janine Halloran. This book has over 75 strategies for kids to try to help them manage their stress and worry. This book also includes colorful worksheets to help kids learn more about their anxiety and what they can do to manage their stress.

Wilma Jean the Worry Machine by Julia Cook I love that when Wilma Jean's physical reactions are described, they're also illustrated. When is says she has knots in her stomach and her knees lock, her stomach really looks like it's tied in a knot and there's a real lock around her knees. I love the activity she does with her teacher, going over worries she can control and worries she can't, it's a great way to help kids manage their anxiety.

David and the Worry Beast by Anne Marie Guanci David's anxiety is a beast, and the more anxious he gets, the bigger it grows. David learns to control his thoughts, and his beast shrinks. There's also a couple of pages for parents and kids in the back.

When My Worries Get Too Big by Kari Dunn Buron This book is wonderful! There are several pages where kids can add in their own thoughts, worries and what helps them relax. This book also uses the 5 point scale to talk about stress and different ways to manage it.

What To Do When You Worry Too Much by Dawn Huebner, PhD This book goes through several ways that can help kids manage anxiety, including setting a time for worries, thinking about things that make you happy and resetting your body with activity or relaxation. There are some interactive places in this book, where a child can write down their worries, draw some images of things that might help, etc.

What To Do When You're Scared and Worried by James J. Crist This is one of my favorite books for kids to help them deal with anxiety. Near the beginning of the book is a checklist that helps kids narrow down what they are anxious about. The beginning of the book covers the basics of what anxiety is and how to help manage with coping skills. The next section of the book goes into detail about different types of anxiety kids might experience, including Separation Anxiety, Phobias and Panic Attacks.

Separation Anxiety

The Kissing Hand by Audrey Penn Classic about managing separation anxiety when kids start school. My daughter's kindergarten teacher read this on our visit to school the first day.

When I miss you by Cornelia Maude Spelman This is perfect for little ones who have a hard time dealing with the fact that they are away from their parents during the day. It suggests a couple of things they can do to help and reassurance that parents will come back at the end of the day.

Wemberley Worried by Kevin Henkes Poor Wemberley worries about everything, and then she gets really worried when she is about to start school.

This E-Course offers you instant support from a Child Therapist.
You will get:
12 Videos that are quick and bite size

14 Exercises that will expand on the skills taught

6 Cheat Sheets that will serve as a reference
Along with the course you get:
Access to the instructor for ongoing support

Downloadable PDF versions of all lessons

Lifetime access to the course

More from Coping Skills for Kids about Anxiety in Children...

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Calming Anxiety - Coping Skills for Kids

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Inside: Kid tested strategies used by child therapists for calming anxiety, including ideas to calm down, books to read and videos that can help

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Resources for Managing Stressful Emotions

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Resources for Managing Stressful Emotions

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This page contains affiliate links, read the disclosure statement Inside: Kid tested strategies used by child therapists for calming anxiety, including ideas to calm down, books to read and videos that can help
It's happening again. Your daughter is frustrated and stomping away down to her room, slamming the door and in general "has her cranky pants on". You say calm down, but she yells back "I don't know how to do that!!!"

We tend to tell our kids to "calm down" without ever giving them explicit directions on how to deal with stress and anxiety. Here's a collection of the best tools and tips I've found to teach children how to calm down and relax.

Sometimes you'll need a quick way to help your child calm down and you don't have much with you. Maybe it's when you're out at Target or stuck in traffic. These tips will come in handy at those times:

Imagine your favorite place - it's like taking a mini vacation wherever you are

Think of your favorite things

Name animals alphabetically (alligator, bear, cow, dog, etc...)

Squeeze Something (play dough, clay, silly putty, your fists, a stress ball)

Get a Cold Drink of Water

54321 Grounding - go through each of your 5 senses

1. Put your arms straight out in front of you, palms facing out.

2. Put one hand over the other at the wrists and interlace your fingers.

3. Swoop your hands and arms toward your body and then place your interlaced hands on your chest.

4. Cross your feet at the ankles and put your tongue on the roof of your mouth.

5. Stay still for one minute.

It's great to have a big list of coping skills to try when your child needs to calm down. Here are two more short lists of ideas for calming down at home or at school.

From Imperfect Families - Strategies to use at home

From Encourage Play - 10 Strategies to Help Kids Calm Down at school or home

People usually roll their eyes initially when they hear "breathing is important". But I will continue to say it and explain why. It's so simple, yet has such a big impact on your body's physiology.

When you and calm and relaxed, your body is in "rest and digest" mode. You breathe normally, your heart rate is lower and your muscles are relaxed. However, when stress or anxiety or anger occurs, your body automatically switches into "flight, fight or freeze" mode. Your muscles tense up, your heart rate increases and your breathing becomes more shallow.

Taking deep breaths, instead of shallow breaths, is one way to tell your body to get back to resting and digesting. That's why deep breathing is important!

Luckily, there are some fun ways to teach kids deep breathing techniques

Things to use

Things to say

Breathe in like you are smelling a flower, breathe out like you are blowing out birthday candles

Arms up and breathe in, arms down and breathe out

Pretend your belly is a balloon. Breathe in and make the balloon bigger, then breathe out and make the balloon shrink.

Videos to watch
4 - 7 - 8 Breathing by GoZen
Breathing at Sea Otter Cove from Stress Free Kids

A Coping Skills Toolbox is a kit that you create to help your child calm down when they are upset, anxious or worried. In order to get the most benefit from this, you should create this kit before an issue occurs. When your child experiences anxiety, then they can pick out an item from their Coping Skills Toolbox. This is one of my favorite ways to help kids learn to calm their anxiety.

Here are some other fantastic ideas for what to put in a coping skills toolbox/calm down kit from And Next Comes L

You can create a place specially designed to allow to calm down in a few steps

Find a spot and make it cozy (ask your child for help with that - maybe they can place a favorite blanket or stuffed animal inside)

Add calming tools

Explain how to use it and practice before

When they are starting to escalate, catch it early and give them a calm reminder about their calm down spot

Use the following phrases as a way to support your child, let them know that you're going to support them and help them in any way that you can.

"I'm here for you"

"Talk to me and tell me what's going on"

"How can I help?"

"Together, we can work on this. We're a great team"

"I love you"

"Do you want a hug?"

Here are some more ideas of what to say to calm an anxious child.

From Go Zen - 49 Phrases to Calm an Anxious Child

From Lemon Lime Adventures - What to Say to Calm an Anxious Child

Did you know there are podcasts with stories for children? Usually the hosts have a soothing voice and the stories tend to be pretty short. Your child can listen to these podcasts as a way to have some down time.

There are scripts you can read to your child to help them relax and calm down. Slowly and carefully read the words as your child listens and follows the instructions. Check out Inner Health Studios list of scripts you can use with your child. If you prefer not to read a script, there are ones that are pre-recorded.

There are also scripts to practice mindfulness with children. Eline Snel has written a great book on Mindfulness with Kids, Sitting Still Like a Frog. Here are the several scripts that can be used from that book!

Annaka Harris also has several pre-recorded scripts to help kids practice mindfulness

Confused about how to introduce mindfulness to kids? Check out these resources:
Simple Ways to Introduce Mindfulness and Meditation to Children 11 Simple But Effective Ways to Teach Mindfulness to Kids
What you need:

I've used empty soda bottles, empty water bottles, glass jars and plastic containers. Use whatever makes sense for you and your family. For instance, for the calming jars the kids have in their room, I used a heavy duty plastic bottle. I didn't want them to accidentally knock over a glass jar in the dark - that would be a huge mess!

I've had the best results when I've used warm water - it makes it easier for the water and paint to combine.
Glitter Paint
I prefer using glitter paint (or glitter glue) instead of glitter because then I'm not cleaning up glitter for weeks at my house after we make them :-)

To make your jar, add glitter paint to the bottom of the jar until it just covers the bottom of it. Add warm water. Put the cover on and shake to help the ingredients combine. Once you are satisfied with the look of your jar, then you can super glue the lid shut so it doesn't spill. In a pinch, I've also used duct tape to secure the lid.
Watch Make a Simple Calming Jar from Coping Skills for Kids on YouTube Wet Ingredients
Sometimes you want the glitter/other items to stay afloat longer or for a shorter amount of time. Here are some different ingredients you can use as the wet ingredients.
Dry Ingredients
To see several other ways to make calming jars, take a look at what Preschool Inspirations did.

One of the first things I always like to do with kids if they are struggling is to start using visuals. When you're stressed and anxious, it's harder to read and take in information. Visuals are easier.

I like to keep calming cue cards in my children's coping skills toolboxes so that they can make a decision about what coping skill they can use. Sometimes pulling out a list is too much in the moment. You can make your own cue cards.

1. Take several index cards or small pieces of cardstock

2. On each one, write or draw one coping skill

3. Hole punch the cards and place them on a keyring (to make them extra sturdy, you can laminate them)

4. Put them into the coping skills toolbox for easy access

Using visuals is a powerful way to help kids. When kids are overwhelmed, sometimes it's hard for them to figure out what to do. By having cue cards, your child can have a visual reminder of what calms and relaxes them.

To make things a little easier, I've created ready to use coping skills cue cardsfor you. There are four different sets: Calming, Physical, Distracting, and Processing. If you'd like all 4, I created a set where you can download them all together.

If your child is anxious, they may also be having a difficult time getting settled for bedtime. Here are some ideas to help your child get settled at bedtime.

PINPOINT WHAT THE FEAR IS

One of the most important things to do is to figure out exactly what is causing the anxiety. Is it fear of the dark? Is it a worry about something in the closet? Is it monsters? Is it spiders? Figuring out the cause of the fear will help you come up with ways you can help your child combat it.

REARRANGE THE ROOM

Are there particular spots of the room that seem to be darker or cause more fear at night than others? Go into the bedroom during the day with your child and talk about the spots that make your child nervous. Try moving night lights and furniture around for a more calming room arrangement.

TRANSITIONAL OBJECTS

If your child has a hard time separating from you, try a transitional object. This is a special item that helps your child feel comforted. It helps them feel like part of you is still present even when you're not there. It could be something like a stuffed animal or a special stone or necklace, or a sweatshirt of yours. The object isn't what matters, it's what the object represents. They can keep it and hold it all night long to help them relax and go to sleep.

Find more strategies here: 12 Kid Friendly Strategies to Calm Anxiety at Night

Looking for some calming guided meditation to help get to sleep at night? Try one of these: Best Guided Meditations for Sleep.

Whenever I sit down and talk with someone about their coping skills, one of the first
things I ask is if they have tried writing about it. Why do I always start with journaling as
a way of processing through difficult feelings?

It's easier to write about than talk about hard things

Journaling helps you process what's happening.

It's convenient.

It's not graded

It can help you solve a problem

It can help you re-frame your thinking

Looking for a journal for a child or teen? Check out Big Life Journals!

General Anxiety

The Coping Skills for Kids Workbook by Janine Halloran. This book has over 75 strategies for kids to try to help them manage their stress and worry. This book also includes colorful worksheets to help kids learn more about their anxiety and what they can do to manage their stress.

Wilma Jean the Worry Machine by Julia Cook I love that when Wilma Jean's physical reactions are described, they're also illustrated. When is says she has knots in her stomach and her knees lock, her stomach really looks like it's tied in a knot and there's a real lock around her knees. I love the activity she does with her teacher, going over worries she can control and worries she can't, it's a great way to help kids manage their anxiety.

David and the Worry Beast by Anne Marie Guanci David's anxiety is a beast, and the more anxious he gets, the bigger it grows. David learns to control his thoughts, and his beast shrinks. There's also a couple of pages for parents and kids in the back.

When My Worries Get Too Big by Kari Dunn Buron This book is wonderful! There are several pages where kids can add in their own thoughts, worries and what helps them relax. This book also uses the 5 point scale to talk about stress and different ways to manage it.

What To Do When You Worry Too Much by Dawn Huebner, PhD This book goes through several ways that can help kids manage anxiety, including setting a time for worries, thinking about things that make you happy and resetting your body with activity or relaxation. There are some interactive places in this book, where a child can write down their worries, draw some images of things that might help, etc.

What To Do When You're Scared and Worried by James J. Crist This is one of my favorite books for kids to help them deal with anxiety. Near the beginning of the book is a checklist that helps kids narrow down what they are anxious about. The beginning of the book covers the basics of what anxiety is and how to help manage with coping skills. The next section of the book goes into detail about different types of anxiety kids might experience, including Separation Anxiety, Phobias and Panic Attacks.

Separation Anxiety

The Kissing Hand by Audrey Penn Classic about managing separation anxiety when kids start school. My daughter's kindergarten teacher read this on our visit to school the first day.

When I miss you by Cornelia Maude Spelman This is perfect for little ones who have a hard time dealing with the fact that they are away from their parents during the day. It suggests a couple of things they can do to help and reassurance that parents will come back at the end of the day.

Wemberley Worried by Kevin Henkes Poor Wemberley worries about everything, and then she gets really worried when she is about to start school.

This E-Course offers you instant support from a Child Therapist.
You will get:
12 Videos that are quick and bite size

14 Exercises that will expand on the skills taught

6 Cheat Sheets that will serve as a reference
Along with the course you get:
Access to the instructor for ongoing support

Downloadable PDF versions of all lessons

Lifetime access to the course

More from Coping Skills for Kids about Anxiety in Children...

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Calming Anxiety - Coping Skills for Kids

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Inside: Kid tested strategies used by child therapists for calming anxiety, including ideas to calm down, books to read and videos that can help

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Finding the motivation to make positive lifestyle changes can be hard for anyone. For teenagers, it can be especially difficult when parents are the ones telling them to do it. But if they've fallen into unhealthy habits like vaping or alcohol abuse, change can be beneficial. Motivational interviewing is a form of therapy that creates a safe, non-judgmental environment for teens to establish their own goals and values and see how changing unhealthy behaviors can benefit them in the long run.

This series of articles comes from the Child Mind Institute, with most available in English and Spanish. Why might teens be resistant to therapy and how can parents and others to help them get the treatment they need? The articles explain how motivational interviewing can help teens gain the self-confidence to make important behavioral changes. To read more about motivational interviewing, and to connect with the articles in both English and Spanish, please visit CPIR's abstract.

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Center for Parent Information and Resources | Your Central Hub for Parent Centers Serving Families of Children With Disabilities

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Finding the motivation to make positive lifestyle changes can be hard for anyone. For teenagers, it can be especially difficult when parents are the ones telling them to do it. But if they've fallen into unhealthy habits like vaping or alcohol abuse, change can be beneficial.

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Missouri Comprehensive Counseling Programs.  (2015).  School counselor referral process guide.  https://www.missouricareereducation.org/doc/referral/ReferralProcess.pdf

Pennsylvania Care Partnership.  (n.d.).  Children's mental health disorder fact sheet for the classroom.  https://www.pacarepartnership.org/uploads/MH_fact_sheet_minn07.pdf

Substance Abuse and Mental Health Services Administration.  (2015).  School mental health referral pathways (SMHRP) toolkit.  https://www.escneo.org/Downloads/NITT%20SMHRP%20Toolkit_11%2019%2015%20FINAL.PDF

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Child Mind Institute | Transforming Children’s Lives.

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The Child Mind Institute is an independent nonprofit dedicated to transforming the lives of children struggling with mental health and learning disorders.

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School counselors offer services designed to increase student wellness, improve academic performance, and increase participation in postsecondary education. School counselors support students in their academic, career, and social-emotional development. They help students achieve success in school, pursue post-secondary opportunities, and lead healthy, fulfilling lives. As described in Texas Education Code (TEC) §33.005 and §33.006, a school counselor works with school faculty and staff, students, parents, and the community to plan, implement, and evaluate a comprehensive school counseling program (CSCP). The school's CSCP includes the following four components:

Guidance Curriculum

Through a guidance curriculum, a school counselor guides students in developing their full educational potential and serves as a critical Tier I support for all students. This curriculum helps students develop competencies that align with the knowledge, attitudes, and skills appropriate for their developmental level. The guidance curriculum is delivered systematically by school counselors in collaboration with other professional educators. The curriculum includes K-12 classroom lessons and group activities.

Individual Student Planning

Through Individual Student Planning, a school counselor guides each student in planning, monitoring, and managing their educational, career, personal, and social development. To achieve this, school counselors work with other educational professionals to implement systemic activities that guide students in creating future goals and plans.

Responsive Services

Through the responsive services component, school counselors intervene on behalf of any student whose immediate personal concerns or problems put the student's continued educational, career, personal, or social development at risk. This can include preventive, remedial, or crisis situations. Responsive services are implemented through individual or small-group counseling, as well as through crisis response.

System Support

System support is the foundation of the comprehensive school counseling program (CSCP). School counselors plan, organize, implement, manage, and evaluate their school counseling program to increase efficiency and efficacy. In addition, school counselors coordinate with providers in the broad network of interrelated services offered in the school, district, and community to ensure individual student needs are met.

American School Counselor Association: A professional development association dedicated to supporting school counselors' efforts to help students focus on academic, career, and social/emotional development so they achieve success in school and are prepared to lead fulfilling lives as responsible members of society.

Lone Star State School Counselor Association: A professional development association dedicated to providing services and resources to meet the needs of school counselors across our great state of Texas.

Texas School Counselor Association: A professional development association dedicated to serving professional school counselors by advocating for and advancing the role of the professional school counselor and the comprehensive school guidance and counseling program throughout Texas.

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School counselors offer services designed to increase student wellness, improve academic performance, and increase participation in postsecondary education. School counselors support students in their academic, career, and social-emotional development. They help students achieve success in school, pursue post-secondary opportunities, and lead healthy, fulfilling lives.

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Home - American School Counselor Association (ASCA)

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School-Counselor.org | School Counselor / Guidance Counselor Career Information

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School Counselor Resources - The School Counselor Toolkit

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The School Counselor Toolkit. Explore School-Counselor.org’s resources for school counselors.

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Resources for Managing Stressful Emotions

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Resources for Managing Stressful Emotions

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This page contains affiliate links, read the disclosure statement Inside: Kid tested strategies used by child therapists for calming anxiety, including ideas to calm down, books to read and videos that can help
It's happening again. Your daughter is frustrated and stomping away down to her room, slamming the door and in general "has her cranky pants on". You say calm down, but she yells back "I don't know how to do that!!!"

We tend to tell our kids to "calm down" without ever giving them explicit directions on how to deal with stress and anxiety. Here's a collection of the best tools and tips I've found to teach children how to calm down and relax.

Sometimes you'll need a quick way to help your child calm down and you don't have much with you. Maybe it's when you're out at Target or stuck in traffic. These tips will come in handy at those times:

Imagine your favorite place - it's like taking a mini vacation wherever you are

Think of your favorite things

Name animals alphabetically (alligator, bear, cow, dog, etc...)

Squeeze Something (play dough, clay, silly putty, your fists, a stress ball)

Get a Cold Drink of Water

54321 Grounding - go through each of your 5 senses

1. Put your arms straight out in front of you, palms facing out.

2. Put one hand over the other at the wrists and interlace your fingers.

3. Swoop your hands and arms toward your body and then place your interlaced hands on your chest.

4. Cross your feet at the ankles and put your tongue on the roof of your mouth.

5. Stay still for one minute.

It's great to have a big list of coping skills to try when your child needs to calm down. Here are two more short lists of ideas for calming down at home or at school.

From Imperfect Families - Strategies to use at home

From Encourage Play - 10 Strategies to Help Kids Calm Down at school or home

People usually roll their eyes initially when they hear "breathing is important". But I will continue to say it and explain why. It's so simple, yet has such a big impact on your body's physiology.

When you and calm and relaxed, your body is in "rest and digest" mode. You breathe normally, your heart rate is lower and your muscles are relaxed. However, when stress or anxiety or anger occurs, your body automatically switches into "flight, fight or freeze" mode. Your muscles tense up, your heart rate increases and your breathing becomes more shallow.

Taking deep breaths, instead of shallow breaths, is one way to tell your body to get back to resting and digesting. That's why deep breathing is important!

Luckily, there are some fun ways to teach kids deep breathing techniques

Things to use

Things to say

Breathe in like you are smelling a flower, breathe out like you are blowing out birthday candles

Arms up and breathe in, arms down and breathe out

Pretend your belly is a balloon. Breathe in and make the balloon bigger, then breathe out and make the balloon shrink.

Videos to watch
4 - 7 - 8 Breathing by GoZen
Breathing at Sea Otter Cove from Stress Free Kids

A Coping Skills Toolbox is a kit that you create to help your child calm down when they are upset, anxious or worried. In order to get the most benefit from this, you should create this kit before an issue occurs. When your child experiences anxiety, then they can pick out an item from their Coping Skills Toolbox. This is one of my favorite ways to help kids learn to calm their anxiety.

Here are some other fantastic ideas for what to put in a coping skills toolbox/calm down kit from And Next Comes L

You can create a place specially designed to allow to calm down in a few steps

Find a spot and make it cozy (ask your child for help with that - maybe they can place a favorite blanket or stuffed animal inside)

Add calming tools

Explain how to use it and practice before

When they are starting to escalate, catch it early and give them a calm reminder about their calm down spot

Use the following phrases as a way to support your child, let them know that you're going to support them and help them in any way that you can.

"I'm here for you"

"Talk to me and tell me what's going on"

"How can I help?"

"Together, we can work on this. We're a great team"

"I love you"

"Do you want a hug?"

Here are some more ideas of what to say to calm an anxious child.

From Go Zen - 49 Phrases to Calm an Anxious Child

From Lemon Lime Adventures - What to Say to Calm an Anxious Child

Did you know there are podcasts with stories for children? Usually the hosts have a soothing voice and the stories tend to be pretty short. Your child can listen to these podcasts as a way to have some down time.

There are scripts you can read to your child to help them relax and calm down. Slowly and carefully read the words as your child listens and follows the instructions. Check out Inner Health Studios list of scripts you can use with your child. If you prefer not to read a script, there are ones that are pre-recorded.

There are also scripts to practice mindfulness with children. Eline Snel has written a great book on Mindfulness with Kids, Sitting Still Like a Frog. Here are the several scripts that can be used from that book!

Annaka Harris also has several pre-recorded scripts to help kids practice mindfulness

Confused about how to introduce mindfulness to kids? Check out these resources:
Simple Ways to Introduce Mindfulness and Meditation to Children 11 Simple But Effective Ways to Teach Mindfulness to Kids
What you need:

I've used empty soda bottles, empty water bottles, glass jars and plastic containers. Use whatever makes sense for you and your family. For instance, for the calming jars the kids have in their room, I used a heavy duty plastic bottle. I didn't want them to accidentally knock over a glass jar in the dark - that would be a huge mess!

I've had the best results when I've used warm water - it makes it easier for the water and paint to combine.
Glitter Paint
I prefer using glitter paint (or glitter glue) instead of glitter because then I'm not cleaning up glitter for weeks at my house after we make them :-)

To make your jar, add glitter paint to the bottom of the jar until it just covers the bottom of it. Add warm water. Put the cover on and shake to help the ingredients combine. Once you are satisfied with the look of your jar, then you can super glue the lid shut so it doesn't spill. In a pinch, I've also used duct tape to secure the lid.
Watch Make a Simple Calming Jar from Coping Skills for Kids on YouTube Wet Ingredients
Sometimes you want the glitter/other items to stay afloat longer or for a shorter amount of time. Here are some different ingredients you can use as the wet ingredients.
Dry Ingredients
To see several other ways to make calming jars, take a look at what Preschool Inspirations did.

One of the first things I always like to do with kids if they are struggling is to start using visuals. When you're stressed and anxious, it's harder to read and take in information. Visuals are easier.

I like to keep calming cue cards in my children's coping skills toolboxes so that they can make a decision about what coping skill they can use. Sometimes pulling out a list is too much in the moment. You can make your own cue cards.

1. Take several index cards or small pieces of cardstock

2. On each one, write or draw one coping skill

3. Hole punch the cards and place them on a keyring (to make them extra sturdy, you can laminate them)

4. Put them into the coping skills toolbox for easy access

Using visuals is a powerful way to help kids. When kids are overwhelmed, sometimes it's hard for them to figure out what to do. By having cue cards, your child can have a visual reminder of what calms and relaxes them.

To make things a little easier, I've created ready to use coping skills cue cardsfor you. There are four different sets: Calming, Physical, Distracting, and Processing. If you'd like all 4, I created a set where you can download them all together.

If your child is anxious, they may also be having a difficult time getting settled for bedtime. Here are some ideas to help your child get settled at bedtime.

PINPOINT WHAT THE FEAR IS

One of the most important things to do is to figure out exactly what is causing the anxiety. Is it fear of the dark? Is it a worry about something in the closet? Is it monsters? Is it spiders? Figuring out the cause of the fear will help you come up with ways you can help your child combat it.

REARRANGE THE ROOM

Are there particular spots of the room that seem to be darker or cause more fear at night than others? Go into the bedroom during the day with your child and talk about the spots that make your child nervous. Try moving night lights and furniture around for a more calming room arrangement.

TRANSITIONAL OBJECTS

If your child has a hard time separating from you, try a transitional object. This is a special item that helps your child feel comforted. It helps them feel like part of you is still present even when you're not there. It could be something like a stuffed animal or a special stone or necklace, or a sweatshirt of yours. The object isn't what matters, it's what the object represents. They can keep it and hold it all night long to help them relax and go to sleep.

Find more strategies here: 12 Kid Friendly Strategies to Calm Anxiety at Night

Looking for some calming guided meditation to help get to sleep at night? Try one of these: Best Guided Meditations for Sleep.

Whenever I sit down and talk with someone about their coping skills, one of the first
things I ask is if they have tried writing about it. Why do I always start with journaling as
a way of processing through difficult feelings?

It's easier to write about than talk about hard things

Journaling helps you process what's happening.

It's convenient.

It's not graded

It can help you solve a problem

It can help you re-frame your thinking

Looking for a journal for a child or teen? Check out Big Life Journals!

General Anxiety

The Coping Skills for Kids Workbook by Janine Halloran. This book has over 75 strategies for kids to try to help them manage their stress and worry. This book also includes colorful worksheets to help kids learn more about their anxiety and what they can do to manage their stress.

Wilma Jean the Worry Machine by Julia Cook I love that when Wilma Jean's physical reactions are described, they're also illustrated. When is says she has knots in her stomach and her knees lock, her stomach really looks like it's tied in a knot and there's a real lock around her knees. I love the activity she does with her teacher, going over worries she can control and worries she can't, it's a great way to help kids manage their anxiety.

David and the Worry Beast by Anne Marie Guanci David's anxiety is a beast, and the more anxious he gets, the bigger it grows. David learns to control his thoughts, and his beast shrinks. There's also a couple of pages for parents and kids in the back.

When My Worries Get Too Big by Kari Dunn Buron This book is wonderful! There are several pages where kids can add in their own thoughts, worries and what helps them relax. This book also uses the 5 point scale to talk about stress and different ways to manage it.

What To Do When You Worry Too Much by Dawn Huebner, PhD This book goes through several ways that can help kids manage anxiety, including setting a time for worries, thinking about things that make you happy and resetting your body with activity or relaxation. There are some interactive places in this book, where a child can write down their worries, draw some images of things that might help, etc.

What To Do When You're Scared and Worried by James J. Crist This is one of my favorite books for kids to help them deal with anxiety. Near the beginning of the book is a checklist that helps kids narrow down what they are anxious about. The beginning of the book covers the basics of what anxiety is and how to help manage with coping skills. The next section of the book goes into detail about different types of anxiety kids might experience, including Separation Anxiety, Phobias and Panic Attacks.

Separation Anxiety

The Kissing Hand by Audrey Penn Classic about managing separation anxiety when kids start school. My daughter's kindergarten teacher read this on our visit to school the first day.

When I miss you by Cornelia Maude Spelman This is perfect for little ones who have a hard time dealing with the fact that they are away from their parents during the day. It suggests a couple of things they can do to help and reassurance that parents will come back at the end of the day.

Wemberley Worried by Kevin Henkes Poor Wemberley worries about everything, and then she gets really worried when she is about to start school.

This E-Course offers you instant support from a Child Therapist.
You will get:
12 Videos that are quick and bite size

14 Exercises that will expand on the skills taught

6 Cheat Sheets that will serve as a reference
Along with the course you get:
Access to the instructor for ongoing support

Downloadable PDF versions of all lessons

Lifetime access to the course

More from Coping Skills for Kids about Anxiety in Children...

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Calming Anxiety - Coping Skills for Kids

# data[].attributes.attachment_link.description
Inside: Kid tested strategies used by child therapists for calming anxiety, including ideas to calm down, books to read and videos that can help

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Overview

Obsessive-compulsive disorder (OCD) features a pattern of unwanted thoughts and fears known as obsessions. These obsessions lead you to do repetitive behaviors, also called compulsions. These obsessions and compulsions get in the way of daily activities and cause a lot of distress.

Ultimately, you feel driven to do compulsive acts to ease your stress. Even if you try to ignore or get rid of bothersome thoughts or urges, they keep coming back. This leads you to act based on ritual. This is the vicious cycle of OCD.

OCD often centers around certain themes, such as being overly fearful of getting contaminated by germs. To ease contamination fears, you may wash your hands over and over again until they're sore and chapped.

If you have OCD, you may be ashamed, embarrassed and frustrated about the condition. But treatment can be effective.

Symptoms

Obsessive-compulsive disorder usually includes both obsessions and compulsions. But it's also possible to have only obsession symptoms or only compulsion symptoms. You may or may not know that your obsessions and compulsions are beyond reason. But they take up a great deal of time, reduce your quality of life, and get in the way of your daily routines and responsibilities.

Obsession symptoms

OCD obsessions are lasting and unwanted thoughts that keeping coming back or urges or images that are intrusive and cause distress or anxiety. You might try to ignore them or get rid of them by acting based on ritual. These obsessions usually intrude when you're trying to think of or do other things.

Obsessions often have themes, such as:

Fear of contamination or dirt.

Doubting and having a hard time dealing with uncertainty.

Needing things to be orderly and balanced.

Aggressive or horrific thoughts about losing control and harming yourself or others.

Unwanted thoughts, including aggression, or sexual or religious subjects.

Examples of obsession symptoms include:

Fear of being contaminated by touching objects others have touched.

Doubts that you've locked the door or turned off the stove.

Intense stress when objects aren't orderly or facing a certain way.

Images of driving your car into a crowd of people.

Thoughts about shouting obscenities or not acting the right way in public.

Unpleasant sexual images.

Staying away from situations that can cause obsessions, such as shaking hands.

Compulsion symptoms

OCD compulsions are repetitive behaviors that you feel driven to do. These repetitive behaviors or mental acts are meant to reduce anxiety related to your obsessions or prevent something bad from happening. But taking part in the compulsions brings no pleasure and may offer only limited relief from anxiety.

You may make up rules or rituals to follow that help control your anxiety when you're having obsessive thoughts. These compulsions are beyond reason and often don't relate to the issue they're intended to fix.

As with obsessions, compulsions usually have themes, such as:

Washing and cleaning.

Checking.

Counting.

Ordering.

Following a strict routine.

Demanding reassurance.

Examples of compulsion symptoms include:

Hand-washing until your skin becomes raw.

Checking doors over and over again to make sure they're locked.

Checking the stove over and over again to make sure it's off.

Counting in certain patterns.

Silently repeating a prayer, word or phrase.

Trying to replace a bad thought with a good thought.

Arranging your canned goods to face the same way.

Severity varies

OCD usually begins in the teen or young adult years, but it can start in childhood. Symptoms usually begin over time and tend to vary in how serious they are throughout life. The types of obsessions and compulsions you have also can change over time. Symptoms generally get worse when you are under greater stress, including times of transition and change. OCD, usually thought to be a lifelong disorder, can have mild to moderate symptoms or be so severe and time-consuming that it becomes disabling.

When to see a doctor

There's a difference between being a perfectionist - someone who needs flawless results or performance - and having OCD. OCD thoughts aren't simply excessive worries about real issues in your life or liking to have things clean or arranged in a specific way.

If your obsessions and compulsions affect your quality of life, see your doctor or mental health professional.

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Causes

The cause of obsessive-compulsive disorder isn't fully understood. Main theories include:

Biology. OCD may be due to changes in your body's natural chemistry or brain functions.

Genetics. OCD may have a genetic component, but specific genes have yet to be found.

Learning. Obsessive fears and compulsive behaviors can be learned from watching family members or learning them over time.

Risk factors

Factors that may raise the risk of causing obsessive-compulsive disorder include:

Family history. Having parents or other family members with the disorder can raise your risk of getting OCD.

Stressful life events. If you've gone through traumatic or stressful events, your risk may increase. This reaction may cause the intrusive thoughts, rituals and emotional distress seen in OCD.

Other mental health disorders. OCD may be related to other mental health disorders, such as anxiety disorders, depression, substance abuse or tic disorders.

Complications

Issues due to obsessive-compulsive disorder include:

Excessive time spent taking part in ritualistic behaviors.

Health issues, such as contact dermatitis from frequent hand-washing.

Having a hard time going to work or school or taking part in social activities.

Troubled relationships.

Poor quality of life.

Thoughts about suicide and behavior related to suicide.

Prevention

There's no sure way to prevent obsessive-compulsive disorder. However, getting treated as soon as possible may help keep OCD from getting worse and disrupting activities and your daily routine.

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Obsessive-compulsive disorder (OCD) - Symptoms and causes

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OCD features unwanted thoughts and fears, or obsessions. These obsessions lead to repetitive behaviors, also known as compulsions, that get in the way of daily activities.

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What Are Signs of OCD in Children and Teens?

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All kids have worries and doubts. But kids with obsessive-compulsive disorder (OCD) often can't stop worrying, no matter how much they want to. And those worries frequently compel them to behave in certain ways over and over again.

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Obsessive-compulsive disorder, or OCD, affects 1 in 40 adults and 1 in 100 children, according to the . Sometimes when people think of OCD, they think of humerus characters from TV shows or movies who like to sit in a particular seat, or who need to wash their hands repeatedly, but in reality, OCD is no laughing matter. What might seem like a funny quirk to outsiders is an overwhelming compulsion to those living with OCD. Additionally, OCD doesn't only affect those who have been diagnosed - loved one of those struggling with OCD can be affected as well.

OCD can appear in various forms, and be composed of compulsions and obsessions. Obsessions are thoughts, images, or impulses that repeat again and again; usually there is a feeling of being out of control when obsessive thoughts are present. Obsessions can leave those experiencing them with a feeling of fear, disgust, or restlessness. OCD obsession can also manifest itself in the form of intrusive thoughts that may lead to severe anxiety or panic attacks.

Compulsions are used to "fix" or "correct" the thoughts or feelings brought on by a person's obsessions. An example might be if a third party sets the table for a person suffering from OCD at a restaurant that person may then need to reorganize the table to "fix" the incorrectness of the previous arrangement. Compulsions can manifest in a variety of forms.

At Family Psychiatry and Therapy , we understand that OCD is more than just "quirks," and strive to help both our patients and their loved ones find personalized coping mechanisms and solutions to some of OCDs biggest challenges. No two cases of OCD are the same, so why should your care be? Our friendly staff takes the time to build relationships with each of our clients to ensure that we are devising the best treatment plan. Below we have listed out seven strategies to cope with OCD. Always keep in mind that OCD is not the fault of the one affected, OCD is a medical condition just like any other illness and should be viewed as such.

OCD can feel like an uncontrollable force that is just waiting to pounce, sort of like the monster that use to live under your bed when you were a child. Instead of allowing your OCD to be a faceless villain, give it a name and a shape. Maybe you want to call your OCD Bully, Bob, or Buddy. Whatever name you give it will help bring your OCD out of the shadows and into the light, making it easier to acknowledge its existence. Next, give your OCD a shape; it can be anything from a purple blob to a cheetah.

If your child is suffering from OCD use this approach to discuss his or her OCD. For example, if you want to talk about your child's OCD levels or actions at school that day you might say something along the lines of "How did your Bully do at school today?" or "Did Bob act up while you were at school today?" Viewing OCD as a separate entity can be helpful for both children and adults, always remember that OCD is not your fault and there is no reason to be ashamed.

You may have seen some people keep food journals to keep track of what they eat every day while on a diet, well an OCD journal plays the same role. An OCD journal can help you keep track of your triggers or find new ones, and help you assess the state of your overall OCD. Carry your OCD journal with you everywhere you go and record what happened after you have completed a compulsion.

Journal Example:

Used a public keypad

The keypad was covered in germs. I could contract a serious illness and spread it to everyone I love.

Wash hands and arms

Washed hands and arms three times for 30 seconds for each washing cycle. Then dried hands for two 30-second cycles.

When you are done journaling for the day and read over your entries, then ask yourself the below questions.

1. Why did these situations trigger my OCD?

2. What would have happened if I hadn't performed my resolutions?

3. What evidence is there that shows that my fear, "contract a serious illness and spread it to everyone I love" would actually come true?

Exposure and Response Prevention (ERP)

ERP is a common way of facing and possibly relieving OCD. When using ERP one exposes him or herself to a situation that results in an obsession and then does not engage in their compulsion. Try building an OCD ladder by listing out your fears and subsequent triggers on a 10 rung ladder in order of severity from 1-10.

When you begin ERP start with a first level trigger, once you have confronted your trigger begin by waiting 10 seconds before using your compulsion. Slowly build up the amount of time before using your compulsion until you can stand to perform the task or confront the situation without needing your compulsion. Progress up your OCD ladder as you conquer your triggers.

If you are experiencing OCD compulsions or obsessions, or you feel one coming on try to refocus your attention from the situation. Refocusing your attention can be done physically or mentally. If at the end of the refocusing period you still feel the need to complete your obsession try repeating the session again.
Physically Refocus Your Attention By:

Pet a furry animal such as your cat or dog
Mentally Refocus Your Attention By:
Make sure that while you are working to cope with your OCD, you are taking the time to celebrate your successes. Battling OCD is hard, so when success is achieved it should be celebrated just like any other accomplishment. Determine your rewards before challenging yourself. For example, you could decide that if you can wait 20 seconds before completing your compulsion, then you are going to order pizza for dinner! You don't need to have rewards or create expectations for every scenario, because that could create more stress. Maybe at the end of the week you could reward yourself for any progress you've made, or if you do decide to face a compulsion head on then reward yourself right away. The balance is up to you.

Living with and battling OCD is hard work that can be made even harder when stress is present. Stress has been shown to significantly increase OCD in people, so keeping your stress level down is crucial. Be sure to include time to destress in your daily schedule. Whether you decide to go for a run, read a book, or watch some TV, finding an hour of time every day to destress can be incredibly beneficial.

It's easy to spiral into a loop of self-doubt and blame, but try to break that cycle. If you start feeling guilty for having OCD remind yourself that you have a diagnosed medical condition. Would you be angry at your friend who had asthma if he needed to stop and take his inhaler? Of course not, so you don't need to feel guilty when you perform behaviors that are out of the norm or cause a slight delay. You have a medical condition and are working with it. End of story, no guilt needed.

Take Control of Your OCD Today

Coping with OCD can be hard, so if you're ready to take the next step in battling your OCD we're ready to help. At Family Psychiatry and Therapy our mission is to restore and rebuild lives while leading the way in transformational care so that every individual assisted can achieve what is possible. We'll work with you to build a custom tailored plan to work on your OCD. We are conveniently open Monday - Friday from 9am-7pm everyday. We're ready to help you get on the road to success today.

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7 Strategies to Cope With OCD - Family Psychiatry & Therapy

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Obsessive-compulsive disorder, or OCD, affects 1 in 40 adults and 1 in 100 children, according to the . Sometimes when people think of OCD, they think of humerus characters from TV shows or movies who like to sit in a particular seat, or who need to wash their hands repeatedly, but in reality, OCD is no laughing matter.

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Overview

If you have a mood disorder, your general emotional state or mood is distorted or inconsistent with your circumstances and interferes with your ability to function. You may be extremely sad, empty or irritable (depressed), or you may have periods of depression alternating with being excessively happy (mania).

Anxiety disorders can also affect your mood and often occur along with depression. Mood disorders may increase your risk of suicide.

Some examples of mood disorders include:

Major depressive disorder - prolonged and persistent periods of extreme sadness

Bipolar disorder - also called manic depression or bipolar affective disorder, depression that includes alternating times of depression and mania

Seasonal affective disorder (SAD) - a form of depression most often associated with fewer hours of daylight in the far northern and southern latitudes from late fall to early spring

Cyclothymic disorder - a disorder that causes emotional ups and downs that are less extreme than bipolar disorder

Premenstrual dysphoric disorder - mood changes and irritability that occur during the premenstrual phase of a woman's cycle and go away with the onset of menses

Persistent depressive disorder (dysthymia) - a long-term (chronic) form of depression

Disruptive mood dysregulation disorder - a disorder of chronic, severe and persistent irritability in children that often includes frequent temper outbursts that are inconsistent with the child's developmental age

Depression related to medical illness - a persistent depressed mood and a significant loss of pleasure in most or all activities that's directly related to the physical effects of another medical condition

Depression induced by substance use or medication - depression symptoms that develop during or soon after substance use or withdrawal or after exposure to a medication

For most people, mood disorders can be successfully treated with medications and talk therapy (psychotherapy).

When to see a doctor

If you're concerned that you may have a mood disorder, make an appointment to see your doctor or a mental health professional as soon as you can. If you're reluctant to seek treatment, talk to a friend or loved one, a faith leader, or someone else you trust.

Talk to a health care professional if you:

Feel like your emotions are interfering with your work, relationships, social activities or other parts of your life

Have trouble with drinking or drugs

Have suicidal thoughts or behaviors - seek emergency treatment immediately

Your mood disorder is unlikely to simply go away on its own, and it may get worse over time. Seek professional help before your mood disorder becomes severe - it may be easier to treat early on.

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Show references

1. Mood disorders fact sheet. National Institutes of Health. http://report.nih.gov/NIHfactsheets/ViewFactSheet.aspx?csid=48. Accessed Sept. 23, 2017.

2. Brown A. Allscripts EPSi. Mayo Clinic, Rochester, Minn. Aug. 3, 2017.

3. Overview of mood disorders. Merck Manual Professional Version. http://www.merckmanuals.com/professional/psychiatric-disorders/mood-disorders/overview-of-mood-disorders. Accessed Sept. 23, 2017.

4. Mood disorders. MentalHealth.gov. http://www.mentalhealth.gov/what-to-look-for/mood-disorders/index.html. Accessed Sept. 23, 2017.

5. Depressive disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://dsm.psychiatryonline.org. Accessed Sept. 23, 2017.

6. Bipolar and related disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://dsm.psychiatryonline.org. Accessed Sept. 23, 2017.

7. Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 2, 2017.

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Specialists in psychiatry and psychology at Mayo Clinic diagnose and treat adults and children with depression, bipolar disorder and other mood disorders.

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Overview

Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental illness that causes unusual shifts in a person's mood, energy, activity levels, and concentration. These shifts can make it difficult to carry out day-to-day tasks.

There are three types of bipolar disorder. All three types involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely "up," elated, irritable, or energized behavior (known as manic episodes) to very "down," sad, indifferent, or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.

Bipolar I disorder is defined by manic episodes that last for at least 7 days (nearly every day for most of the day) or by manic symptoms that are so severe that the person needs immediate medical care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depressive symptoms and manic symptoms at the same time) are also possible. Experiencing four or more episodes of mania or depression within 1 year is called "rapid cycling."

Bipolar II disorder is defined by a pattern of depressive episodes and hypomanic episodes. The hypomanic episodes are less severe than the manic episodes in bipolar I disorder.

Cyclothymic disorder (also called cyclothymia) is defined by recurring hypomanic and depressive symptoms that are not intense enough or do not last long enough to qualify as hypomanic or depressive episodes.

Sometimes a person might experience symptoms of bipolar disorder that do not match the three categories listed above, and this is referred to as "other specified and unspecified bipolar and related disorders."

Bipolar disorder is often diagnosed during late adolescence (teen years) or early adulthood. Sometimes, bipolar symptoms can appear in children. Although the symptoms may vary over time, bipolar disorder usually requires lifelong treatment. Following a prescribed treatment plan can help people manage their symptoms and improve their quality of life.

Signs and symptoms

Risk factors

Treatments and therapies

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Learn about bipolar disorder, including signs and symptoms, types, risk factors, how it is diagnosed, and potential treatments and therapies.

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Sadness is a natural part of the human experience. People may feel sad or depressed when a loved one passes away or when they're going through a life challenge, such as a divorce or serious illness.

These feelings are normally short-lived. When someone experiences persistent and intense feelings of sadness for extended periods of time, then they may have a mood disorder such as major depressive disorder (MDD).

MDD, also referred to as clinical depression, is a significant medical condition that can affect many areas of your life. It impacts mood and behavior as well as various physical functions, such as appetite and sleep.

MDD is one of the most common mental health conditions in the United States. Data suggests that more than 7 percent of U.S. adults experienced a major depressive episode in 2017.

Some people with MDD never seek treatment. However, most people with the disorder can learn to cope and function with treatment. Medications, psychotherapy, and other methods can effectively treat people with MDD and help them manage their symptoms.

Your doctor or a mental health professional can make a diagnosis of major depressive disorder based on your symptoms, feelings, and behaviors.

Typically, you'll be asked certain questions or given a questionnaire so they can better determine if you have MDD or another diagnosis.

To be diagnosed with MDD, you need to meet the symptom criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual helps medical professionals diagnose mental health conditions.

According to its criteria:

you must experience a change in your previous functioning

symptoms must occur for a period of 2 or more weeks

at least one symptom is either depressed mood or loss of interest or pleasure

You must also experience 5 or more of the following symptoms in the 2-week period:

You feel sad or irritable most of the day, nearly every day.

You're less interested in most activities you once enjoyed.

You suddenly lose or gain weight or have a change in appetite.

You have trouble falling asleep or want to sleep more than usual.

You experience feelings of restlessness.

You feel unusually tired and have a lack of energy.

You feel worthless or guilty, often about things that wouldn't normally make you feel that way.

You have difficulty concentrating, thinking, or making decisions.

You think about harming yourself or suicide.

The exact cause of MDD isn't known. However, there are several factors that can increase your risk of developing the condition.

A combination of genes and stress can affect brain chemistry and reduce the ability to maintain mood stability.

Changes in the balance of hormones might also contribute to the development of MDD.

MDD may also be triggered by:

alcohol or drug use

certain medical conditions, such as cancer or hypothyroidism

particular types of medications, including steroids

abuse during childhood

MDD is often treated with medication and psychotherapy. Some lifestyle adjustments can also help ease certain symptoms.

People who have severe MDD or who have thoughts of harming themselves may need to stay in a hospital during treatment. Some might also need to take part in an outpatient treatment program until symptoms improve.

Medications

Primary care providers often start treatment for MDD by prescribing antidepressant medications.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are a frequently prescribed type of antidepressant. SSRIs work by helping inhibit the breakdown of serotonin in the brain, resulting in higher amounts of this neurotransmitter.

Serotonin is a brain chemical that's believed to be responsible for mood. It may help improve mood and produce healthy sleeping patterns.

People with MDD are often thought to have low levels of serotonin. An SSRI can relieve symptoms of MDD by increasing the amount of available serotonin in the brain.

SSRIs include well-known drugs such as fluoxetine (Prozac) and citalopram (Celexa). They have a relatively low incidence of side effects that most people tolerate well.

Similar to SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs) are another type of antidepressant often prescribed. These affect serotonin and norepinephrine.

Other medications

Tricyclic antidepressants and medications known as atypical antidepressants, such as bupropion (Wellbutrin), may be used when other drugs haven't helped.

These drugs can cause several side effects, including weight gain and sleepiness. As with any medication, benefits and side effects need to be weighed carefully with your doctor.

Some medications used to treat MDD aren't safe while pregnant or breastfeeding. Make sure you speak to a healthcare provider if you become pregnant, you're planning to become pregnant, or you're breastfeeding.

Psychotherapy

Psychotherapy, also known as psychological therapy or talk therapy, can be an effective treatment for people with MDD. It involves meeting with a therapist on a regular basis to talk about your condition and related issues.

Psychotherapy can help you:

adjust to a crisis or other stressful event

replace negative beliefs and behaviors with positive, healthy ones

improve your communication skills

find better ways to cope with challenges and solve problems

increase your self-esteem

regain a sense of satisfaction and control in your life

Your healthcare provider may also recommend other types of therapy, such as cognitive behavioral therapy or interpersonal therapy. If you don't already have a healthcare provider, the Healthline FindCare tool can help you find a physician in your area.

Another possible treatment is group therapy, which allows you to share your feelings with people who can relate to what you're going through.

Lifestyle changes

In addition to taking medications and participating in therapy, you can help improve MDD symptoms by making some changes to your daily habits.

Eat right

Nutritious foods benefit your mind and body, and while no foods can cure depression, certain healthy food choices can benefit your mental well-being.

Consider eating foods:

Avoid alcohol and certain processed foods

It's beneficial to avoid alcohol, as it's a nervous system depressant that can make your symptoms worse.

Also, certain refined, processed, and deep-fried foods contain omega-6 fatty acids, which may contribute to MDD.

Get plenty of exercise

Although MDD can make you feel very tired, it's important to be physically active. Exercising, especially outdoors and in moderate sunlight, can boost your mood and make you feel better.

Sleep well

It's vital to get enough sleep per night, which can vary from person to person but typically ranges between 7-9 hours.

People with depression often have trouble with sleeping. Speak to a doctor if you're having trouble sleeping or oversleeping.

While someone with MDD can feel hopeless at times, it's important to remember that the disorder can be treated successfully. There is hope.

To improve your outlook, it's critical to stick with your treatment plan. Don't miss therapy sessions or follow-up appointments with your healthcare provider.

You should also never stop taking your medications unless you're instructed to do so by your therapist or healthcare provider.

On days when you feel particularly depressed despite treatment, it can be helpful to call a local crisis or mental health service, or the National Suicide Prevention Lifeline. Resources are available.

A friendly, supportive voice could be just what you need to get you through a difficult time.

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Sadness is a natural part of the human experience. People may feel sad or depressed when a loved one passes away or when they're going through a life challenge, such as a divorce or serious illness. These feelings are normally short-lived.

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Mood Disorders in Children & Adolescents

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Mood Disorders in Children & Adolescents

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Mental health problems ranging from depression to bipolar disorder are known as mood disorders, or affective disorders. In any of these disorders, a serious change in mood shapes your child's emotional state. Unlike a normal bad mood a child feels occasionally, a mood disorder involves thoughts and feelings that are intense, difficult to manage, and persistent. A mood disorder is a real medical condition, not something a child will likely just "get over" on his own.

Today, clinicians and researchers believe that mood disorders in children remain one of the most underdiagnosed health problems. Mood disorders that go undiagnosed can put kids at risk for other conditions, like disruptive behavior and substance use disorders, that remain after the mood disorder is treated. Children and teens with a mood disorder don't always show the same symptoms as adults. So it can be difficult for parents to recognize a problem in their child, especially since he or she may not easily express his or her thoughts or feelings.

The most common mood disorders in children and adolescents include:

Major depression. A depressed or irritable mood, lasting at least two weeks.

Persistent depressive disorder (dysthymia). A chronic, low-grade, depressed or irritable mood for at least 1 year.

Bipolar disorder. Periods of persistently elevated mood followed by periods of depressed or flat emotional response.

Disruptive mood dysregulation disorder. A persistent irritability and extreme inability to control behavior.

Premenstrual dysmorphic disorder. This includes depressive symptoms, irritability, and tension before menstruation.

Mood disorder due to a general medical condition. Many medical illnesses, including cancer, injuries, and chronic medical illnesses, can trigger symptoms of depression.

Substance-induced mood disorder. Symptoms of depression due to drug use, the effects of a medication, or exposure to toxins.

Girls are at least twice as likely as boys to develop depression. Boys and girls are equally likely to develop bipolar disorder and obsessive-compulsive disorder.

The causes of mood disorders are not well understood. Imbalances in brain chemicals play a role. Environmental factors, such as unexpected life events and/or chronic stress, can also contribute to a mood disorder.

Mood disorders often run in families, so there is a genetic component, too. Children who have relatives with depression are at increased risk for depression. In addition, a family history of bipolar disorder may predispose a child to have bipolar disorder or other mood disorder.

Sometimes, extreme stress or a life event can "turn on" a gene, causing the disorder to develop. This can happen especially with depression.

Children show symptoms differently, according to their age and biological makeup. Symptoms also vary according to the type of mood disorder. Overall signs of a mood disorder may include:

Sad, depressed, irritable, angry, or elevated mood that appears more intense than the child usually feels, lasts for a longer period of time, or occurs more frequently

Trouble with family, including difficult behavior

Lack of motivation or pleasure in previously enjoyed activities

Changes in sleep or eating patterns or weight

Frequent physical complaints, such as headaches, stomachaches, or fatigue

Loss of energy or fatigue

Difficulty achieving in school

Worthlessness, guilt, or low self-esteem

Severe recurrent temper outbursts

Increased energy or bursts of energy with racing thoughts or fast speech

Rebellious or high risk behavior

Running away or threats of running away from home

Difficulty with friends and peers

Expressions of suicidal thoughts, which should be evaluated immediately

If you believe your child is struggling with a mood disorder, you can ask your pediatrician for a referral to a therapist or child psychiatrist. An accurate diagnosis of the mood disorder, as well as any other conditions, is a crucial first step in managing the disorder effectively. At The Children's Hospital of Philadelphia, a specialist will perform a comprehensive evaluation. The evaluation may assess:

Your child's overall health and medical history

Your child's symptoms

Your child's behavior at home, at school, and with peers

Environmental factors that might be stressors in your child's life

Input from teachers or guidance counselor about issues at school

Your child's past experiences with specific medications or therapies

Your opinion or preference for treatment options

Mood disorders can be treated with evidence-based treatments, especially with early recognition of the problem. Treatment can help manage the episode, reduce the severity of symptoms, and help to prevent future episodes. It can also enhance your child's normal growth and development and improve his or her quality of life and relationships.

A CHOP specialist will design a personalized treatment plan based on your child's symptoms and other factors unique to her situation. The plan may include:
Individual therapy

The specialist will identify key problems in your child's life and help your child learn how to manage these stressors. The specialist may also use a variety of techniques to help your child manage the symptoms of the mood disorder, including

Cognitive-behavioral. This approach involves changing problematic thoughts, feelings, and behaviors that your child may be experiencing.

Interpersonal therapy. This technique focuses on building social skills and helping children with difficult relationships in their lives.

Family therapy
Families play a vital supportive role in any mood disorder. Families, including parents or guardians, can learn methods to help their child manage mood and behavior problems. The specialist may also explore potential stressors in a child's life and patterns of interaction within the family. A consultation with your child's teachers or guidance counselor may also be advised.
Medications
A variety of medications are very effective in treating mood disorders by altering the brain chemicals involved. Depending on the mood disorder and your child's symptoms, medications may reduce the severity or frequency of symptoms, decrease problematic behaviors, improve functioning, and prevent future episodes.

Many children who receive early and adequate treatment for their mood disorder may improve significantly and keep their condition managed with ongoing intervention or support . If the episodes recur, they can usually be managed with therapeutic support, including medications, therapy, and additional resources. Despite the mood disorder, children and adolescents are able to grow, develop, and have meaningful life experiences, especially when their mood disorder is managed appropriately and adequately.

Depending on your child's personalized treatment plan, your child and family may continue to meet with the specialist for a number of weeks or months. The focus of individual and family therapy may change over time, depending on your child's age, progress, and needs. Medication needs may also change over time depending on a number of factors. At CHOP, a specialist will monitor and manage your child's condition closely.

Children with mood disorders have a complexity to their condition that includes biology, genetics, factors like stress and physical health, family and peer dynamics, behavior and thought patterns, and sometimes other conditions operating alongside the mood disorder. This complexity means the accuracy of the diagnosis and assessment of your child is crucial and shapes the treatment approach. The right treatment then determines how effectively the mood disorder is managed-and how well your child flourishes in every domain: home, school, and among peers. The team at CHOP is specially trained to recognize, diagnose, and treat the full range of mood disorders in children. They design a personalized plan for your child based on the latest thinking and approaches to care. Their skill set leads your child to long-term success.

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Mood Disorders in Children and Adolescents

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Mood disorders in teens remain one of the most under-diagnosed mental health problems. These disorders also put teens at risk for other conditions that may persist long after the initial episodes of depression are resolved.

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Anorexia, bulimia and binge-eating disorder affect physical and mental health. Learn about symptoms, causes, risk factors, diagnosis and treatment options.

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Eating disorders are complex illnesses that affect adolescents with increasing frequency. They rank as the third most common chronic illness in adolescent females ( 1), with an incidence of up to 5% ( 2, 3), a rate that has increased dramatically over the past three decades. Two major subgroups of the disorders are recognized: a restrictive form, in which food intake is severely limited (anorexia nervosa), and a bulimic form, in which binge eating episodes are followed by attempts to minimize the effects of overeating via vomiting, catharsis, exercise or fasting (bulimia nervosa). Both anorexia nervosa and bulimia nervosa can be associated with serious biological, psychological and sociological morbidity, and significant mortality.

Although eating disorders occur most frequently in adolescents, reports in the scientific literature often combine findings from adolescents with those from adults or report exclusively on adult samples. Unique features of adolescents and the developmental process of adolescence are often critical considerations in determining the diagnosis, treatment or outcome of eating disorders. Consequently, adolescents need to be considered separately and differentiated from adult patients with eating disorders. This position statement addresses the key issues distilled from the scientific literature and represents a consensus of numerous specialists in adolescent medicine regarding the diagnosis and management of adolescents with eating disorders.

DIAGNOSIS

Diagnostic criteria for eating disorders such as described in DSM-IV ( 4) may not be entirely applicable to adolescents. The wide variability in the rate, timing and magnitude of both height and weight gain during normal puberty; the absence of menstrual periods in early puberty along with the unpredictability of menses soon after menarche; and the lack of psychological awareness regarding abstract concepts (such as self-concept, motivation to lose weight or affective states) owing to normative cognitive development limit the application of those formal diagnostic criteria to adolescents. In addition, clinical features such as pubertal delay, growth retardation or the impairment of bone mineral acquisition may occur at subclinical levels of eating disorders ( 5, 6). The use of strict criteria may preclude the recognition of eating disorders in their early stages and subclinical form (a prerequisite for primary or secondary prevention), and may exclude some adolescents with significantly abnormal eating attitudes and behaviours, such as those who vomit or take laxatives regularly but do not binge ( 7- 9). Finally, abnormal eating habits may result in significant impairment in health ( 10), even in the absence of fulfilment of formal criteria for an eating disorder. For all of these reasons, it is essential to diagnose eating disorders in adolescents in the context of the multiple and varied aspects of normal pubertal growth, adolescent development and the eventual attainment of a healthy adulthood rather than by merely applying formalized criteria.

Position: In clinical practice, the diagnosis of an eating disorder should be considered in an adolescent patient who engages in potentially unhealthy weight control practices and/or demonstrates obsessive thinking about food, weight, shape or exercise and not only in one who meets established diagnostic criteria. In such adolescents, an eating disorder should be considered if the teenager fails to attain or maintain a healthy weight, height, body composition or stage of sexual maturation for sex and age.

MEDICAL COMPLICATIONS

No organ system is spared the effects of eating disorders ( 11- 15). Although the physical signs and symptoms occurring in a patient are primarily related to the weight control behaviours practised, the health care professional must consider their frequency, intensity and duration, as well as the biological vulnerability conferred by the sexual maturity of the patient. The majority of physical complications in adolescents with an eating disorder appear to improve with nutritional rehabilitation and recovery from the eating disorder, but some may be potentially irreversible. The long term consequences are still to be elucidated.

Medical complications in adolescents that are potentially irreversible include growth retardation if the disorder occurs before closure of the epiphyses ( 15- 18); pubertal delay or arrest ( 6, 16, 17); and impaired acquisition of peak bone mass during the second decade of life ( 6, 20, 21), increasing the risk of osteoporosis in adulthood. These features emphasize the importance of medical management and ongoing monitoring by physicians who understand normal adolescent growth and development.

Just as we endorse early recognition of eating disorders through the use of broad developmentally appropriate criteria, we also endorse early intervention to prevent, limit or ameliorate medical complications, some of which are life-threatening. Adolescents who restrict food intake, vomit, purge or binge in any combination, with or without severe weight loss, require treatment even if they do not meet strict criteria for an eating disorder.

Position: Because of the potentially irreversible effects of an eating disorder on physical and emotional growth and development in adolescents, because of the risk of death and because of evidence suggesting improved outcome with early treatment, the threshold for intervention in adolescents should be lower than in adults. Ongoing medical monitoring should continue until the adolescent has demonstrated a return to both medical and psychological health.

NUTRITIONAL DISTURBANCES

Nutritional disturbances are a hallmark of eating disorders and are related to the severity and duration of dysfunctional dietary habits. Although abnormalities of minerals, vitamins and trace elements can occur, they generally are not clinically recognized ( 22). Deprivation of energy (calories) and protein on the other hand are especially important to identify because these elements are crucial to growth ( 23). Moreover, there is evidence that adolescents with eating disorders may be losing critical tissue components, such as muscle mass, body fat and bone mineral ( 5, 21, 24), during a phase of growth when dramatic increases in these elements should be occurring. Complete and ongoing assessment of nutritional status is the basis of management of nutritional disturbances in adolescents with eating disorders.

Position: The evaluation and ongoing management of nutritional disturbances in adolescents with eating disorders should take into account the specific nutritional requirements of patients in the context of pubertal development and activity level.

PSYCHOSOCIAL DISTURBANCES

Eating disorders that develop during adolescence interfere with adjustment to pubertal development ( 25) and the accomplishment of the developmental tasks necessary to become a healthy functioning adult. Social isolation and family conflicts arise at a time when families and peers ought to provide a milieu to support development ( 1, 26). Issues related to self-concept, self-esteem, autonomy, separation from the family, the capacity for intimacy, affective disorders (eg, depression and anxiety) and substance abuse should be addressed in a developmentally appropriate manner ( 27).

All patients should be evaluated for co-morbid psychiatric illness, including disorders of anxiety, depression, dissociation and behaviour. Because adolescents usually live at home or interact with their families on a daily basis, the role of the family should be explored during both evaluation and treatment.

Position: All adolescents with an eating disorder should be evaluated for co-morbid psychiatric illness. Mental health intervention for adolescents with eating disorders should address not only the psychopathology characteristics of eating disorders, but also the accomplishment of the developmental tasks of adolescence and the specific psychosocial issues central to this age group. For most adolescents, family therapy should be considered as an important part of treatment.

TREATMENT GUIDELINES

Because of the complex biopsychosocial aspects of eating disorders in adolescents, the assessment and ongoing management of these conditions appear to be optimal with an interdisciplinary team consisting of professionals from medical, nursing, nutritional and mental health disciplines ( 27). Physical and occupational therapy may be useful adjuncts to treatment. Health care providers should have specific experience in treating eating disorders as well as expertise in working with adolescents and their families. They should be knowledgeable about normal adolescent physical and emotional development.

Both in-patient and out-patient treatments need to be available to adolescents with eating disorders ( 27, 28). Factors that would justify in-patient treatment include significant malnutrition, physiological or physical evidence of medical compromise (such as vital sign instability, dehydration or electrolyte disturbances) even in the absence of significant weight loss, arrested growth and development, failure of out-patient treatment, acute food refusal, uncontrollable binging, vomiting or purging, family dysfunction that prevents effective treatment, and acute medical or psychiatric emergencies ( 28). The goals of treatment are the same in a medical or psychiatric in-patient unit, a day program or out-patient setting: to help the adolescent achieve and maintain both physical and psychological health.

The expertise and dedication of the members of a treatment team who work specifically with adolescents and their families are more important than the particular setting. In fact, traditional settings such as a general psychiatric ward may be less appropriate than an adolescent medical unit, if one of the latter is available ( 18, 28- 30). Some evidence suggests that the outcome for patients treated in adolescent medicine units (both out-patient and in-patient) may be better than that of those treated in traditional psychiatric settings with adult patients ( 28- 30). Smooth transition from in-patient to out-patient care can be facilitated by an interdisciplinary team that provides continuity of care in a comprehensive, coordinated, developmentally oriented manner. Health care specialists with an interest in adolescents are familiar with working not only with the patient, but also with the family, school, coaches and other agencies or individuals who are important influences on healthy adolescent development. Given the evidence that eating disorders can be associated with relapse, recurrence, crossover and the later development of other psychiatric disorders, treatment should be of sufficient frequency, intensity and duration to provide effective intervention.

Position: Adolescents with eating disorders require evaluation and treatment focused on biological, psychological and social features of these complex, chronic health conditions. Assessment and ongoing management should be interdisciplinary and is best accomplished by a team consisting of medical, nursing, nutritional and mental health disciplines. Treatment should be provided by health care providers who have expertise in managing adolescent patients with eating disorders and are knowledgeable about normal adolescent physical and psychological development. Hospitalization of an adolescent with an eating disorder is necessary in the presence of malnutrition, clinical evidence of medical or psychiatric decompensation or failure of out-patient treatment. Ongoing treatment should be delivered with appropriate frequency, intensity and duration.

BARRIERS TO CARE

Interdisciplinary treatment of eating disorders can be time-consuming, relatively prolonged and extremely costly. Lack of access to appropriate interdisciplinary teams or insufficient treatment can result in chronicity, social or psychiatric morbidity, and even death. Some provincial plans limit access to private care resources such as nutrition visits or mental health visits. Absent or low reimbursement rates for psychosocial services results in fewer qualified persons being willing to care for teenagers and young adults with eating disorders.

Some older adolescents are no longer eligible for treatment or coverage because of provincial medical insurance rules. Thus, withdrawal from treatment can occur at an age when leaving home, unemployment or temporary employment is the norm. Some institutions have age limit policies that negatively affect treatment and limit access to care during the transition from paediatric to adult care.

Legislation should provide reimbursement for intervention by multiple disciplines for adolescents with eating disorders. Coverage should ensure that for adolescents, treatment should be dictated by the severity and range of the clinical situation. The promotion of size acceptance and healthy lifestyles, introduction of prevention programs for high risk adolescents, and strategies for early diagnosis and intervention should be encouraged.

Position: Health care reforms should include provisions that address the needs of adolescents with eating disorders and ensure that they not be denied access to care because of absent or inadequate health care coverage.

This position paper was adapted by the CPS Adolescent Medicine Committee from a paper by the Society for Adolescent Medicine. It represents a modification of the version published in the Journal of Adolescent Health (1995;16:476-480). We appreciate the permission of the authors, the Journal of Adolescent Health and the Society for Adolescent Medicine to adapt the manuscript to the Canadian context.

The Society for Adolescent Medicine position paper was prepared by Richard E Kreipe, Neville H Golden, Debra K Katzman, Martin Fisher, Jane Rees, Roger S Tonkin, Tomas J Silber, Garry Sigman, Janet Schebendach, Seth Ammerman and Harry M Hoberman.

Footnotes
ADOLESCENT MEDICINE COMMITTEE
Members: Drs Lionel Dibden, Edmonton, Alberta; Eudice Goldberg, The Hospital for Sick Children, Toronto, Ontario; Karen Mary Leslie, The Hospital for Sick Children, Toronto, Ontario; Andrew Lynk (director responsible), Sydney, Nova Scotia; Roger Tonkin (chair), Gabriola Island, British Columbia; Michael Westwood, Dorval, Quebec

Consultants: Drs Delores Doherty, St John's, Newfoundland; Jean-Yves Frappier, Hôpital Ste-Justine, Montréal, Québec; Miriam Kaufman, The Hospital for Sick Children, Toronto, Ontario; Larry Pancer, Markham, Ontario; Diane Sacks, Toronto, Ontario

The recommendations in this Clinical Practice Guideline do not indicate an exclusive course of treatment or procedure to be followed. Variations, taking into account individual circumstances, may be appropriate.

REFERENCES

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Eating disorders in adolescents: Principles of diagnosis and treatment

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Eating disorders are complex illnesses that affect adolescents with increasing frequency. They rank as the third most common chronic illness in adolescent females ( 1), with an incidence of up to 5% ( 2, 3), a rate that has increased dramatically over the past three decades.

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Eating disorders are not uncommon among teens. Take "Kerri" (not her real name) for example. Upset with a sudden weight gain, the 15-year-old forced herself to throw up after eating her school lunch. It seemed harmless. After all, most of the kids at her lunch table had done it before, and they seemed OK.

Then, after doing it five times, Kerri had a new ritual of vomiting right after eating. She did it at school and then again at home. No one knew -- until Thanksgiving. She had eaten more than usual and told her parents she felt sick. Suddenly, there was a tap on the bathroom door. Kerri's parents were standing outside the door, asking how long she'd been throwing up her food.

"Mason," 14, was also obsessed about his weight. Short and chunky most of his life, Mason had a growth spurt. Now tall and thin, he was determined to never to be "the fat kid" again. Mason hated throwing up. So, he started eating salads with no dressing, running miles each day, and taking laxatives to keep his weight down.

It worked. He looked trim and athletic. But he felt exhausted, fatigued, and irritable. In the middle of the night last winter, Mason became violently ill with stomach cramps and a high fever. His doctor admitted him into the hospital and began running tests to figure out his mystery illness.

Weight obsession affects millions of teenagers today, especially girls. At any given time, one out of every seven women has or is struggling with an eating disorder. One study a few years ago found that 36% of adolescent girls -- more than one out of every three -- believed they were overweight, while 59% were trying to lose weight.

More than 90% of people with an eating disorder are girls. Teenage boys, though, also have body image concerns. Many boys strive for the perfect body by dieting or by doing compulsive exercise.

Eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder, are psychological disorders that involve extreme disturbances in eating behavior. A teen with anorexia refuses to stay at a normal body weight. Someone with bulimia has repeated episodes of binge eating followed by compulsive behaviors such as vomiting or the use of laxatives to rid the body of food. Binge eating is characterized by uncontrolled overeating.

Anorexia nervosa affects as many as one in every 100 females. Teens with anorexia fear gaining weight and are at least 15% below their ideal body weights. They believe the main gauge of self-worth is their body image.

Experts believe many American girls are bulimic and have kept the problem a secret. Bulimia often starts in the late teens and early adulthood. People with bulimia go through cycles of eating enormous amounts of foods followed by purging by vomiting, using laxatives, or diuretics or hours of aerobic exercise.

Warning signs of bulimia include:

Extreme preoccupation about being overweight

Strict dieting followed by high-calorie eating binges

Overeating when distressed

Feeling out of control

Disappearing after a meal

Depressed moods

Alcohol or drug abuse

Frequent use of laxatives or diuretics

Excessive exercising

Irregular menstrual cycles

There is no one cause of an eating disorder. Experts link eating disorders to a combination of factors, such as family relationships, psychological problems, and genetics. The teen may have low self-esteem and be preoccupied with having a thin body. Perhaps they have been bullied because of their weight.

Sometimes, being part of a sport such as ballet, gymnastics, or running, where being lean is encouraged, is associated with eating disorders in teens. In one study, researchers linked anorexia with an obsession with perfectionism -- concern over mistakes, high personal standards, and parental expectations and criticism.

Symptoms of eating disorders may include the following:

A distorted body image

Skipping most meals

Unusual eating habits (such as eating thousands of calories at one meal or skipping meals)

Frequent weighing

Extreme weight change

Constipation

Dental cavities

Erosion of tooth enamel

Loss of hair or nail quality

Hyperactivity and high interest in exercise

Teens with eating disorders are often in denial that anything is wrong. They may be moody, anxious, depressed. They may withdraw from friends, and become overly sensitive to criticism. The problem arises when parents are not aware of these symptoms because the teen keeps them hidden -- just like the trauma, insecurities, depression, or low self-esteem that may help trigger the disorder.

Although there is no easy treatment for eating disorders, they are treatable.

A combination of treatments, including cognitive behavioral therapy and antidepressant medication , can be used to help teens overcome bulimia. Cognitive behavioral therapy helps by identifying and replacing inaccurate thoughts to help change behavior and emotional state.

Anorexia treatment usually involves nutritional feeding, medical monitoring, and psychological treatment.

If left untreated, eating disorders can lead to serious illness and even death.

Along with the lower body weight, girls with anorexia nervosa can lose their menstrual periods (amenorrhea). The loss of periods is associated with osteopenia , early that can lead to painful .

Eating disorders are also linked to other serious health problems, such as kidney disease , liver disease, and heart disease . Each of these health problems requires specific tests and treatment.

If you think you have an eating disorder, talk to your doctor. The sooner you get medical and psychological treatment, the faster you will be on your way to recovery.

If you suspect a family member or friend has an eating disorder, talk with them about the problem.

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Eating disorders, including anorexia and bulimia, are psychological disorders that involve extreme disturbances in eating behavior and are common in teens. Learn more from WebMD.

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Bulimia nervosa is a psychological eating disorder that is characterized by episodes of binge eating followed by inappropriate methods of weight control such as vomiting and fasting. Learn causes, symptoms, and treatment options at WebMD.

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Anorexia Nervosa

Anorexia nervosa is an eating disorder in which people have an intense fear of gaining weight and can become dangerously thin. Signs of anorexia include less than normal weight, negative body image, and obsession with food.

Top Search Terms for Anorexia Nervosa

What Are the Symptoms of Anorexia?

If you think you may have anorexia, it's a good idea to reach out for help. Anorexia is an eating disorder that affects many people.

One of the main signs of anorexia is not eating enough food. You might not eat because you think you'll look perfect if you lose a lot of weight. But starving yourself can make you very sick, or even lead to death, so you need to get help.

Read Article

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Anorexia nervosa is an eating disorder in which people have an intense fear of gaining weight and can become dangerously thin. Signs of anorexia include less than normal weight, negative body image, and obsession with food. Top Search Terms for Anorexia Nervosa What Are the Symptoms of Anorexia?

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Resources for Helping Others with Eating Disorders

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Resources for Helping Others with Eating Disorders

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Understanding your loved one's eating disorder

Eating disorders involve extreme disturbances in eating behaviors-following rigid diets, bingeing on food in secret, throwing up after meals, obsessively counting calories. It's not easy to watch someone you care about damage their health-especially when the solution appears, at least on the outside, to be simple. But eating disorders are more complicated than just unhealthy dietary habits. At their core, they're attempts to deal with emotional issues and involve distorted, self-critical attitudes about weight, food, and body image. It's these negative thoughts and feelings that fuel the damaging behaviors.

People with eating disorders use food to deal with uncomfortable or painful emotions. Restricting food is used to feel in control. Overeating temporarily soothes sadness, anger, or loneliness. Purging is used to combat feelings of helplessness and self-loathing. Over time, people with an eating disorder lose the ability to see themselves objectively and obsessions over food and weight come to dominate everything else in their lives. Their road to recovery begins by identifying the underlying issues that drive their eating disorder and finding healthier ways to cope with emotional pain.

While you can't force a person with an eating disorder to change, you can offer your support and encourage treatment. And that can make a huge difference to your loved one's recovery.

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Types of eating disorders

The most common eating disorders are:

Anorexia. People with anorexia starve themselves out of an intense fear of becoming fat. Despite being underweight or even emaciated, they never believe they're thin enough. In addition to restricting calories, people with anorexia may also control their weight with exercise, diet pills, or purging.

Bulimia. Bulimia involves a destructive cycle of bingeing and purging. Following an episode of out-of-control binge eating, people with bulimia take drastic steps to purge themselves of the extra calories. In order to avoid weight gain they vomit, exercise to excess, fast, or take laxatives.

Binge Eating Disorder. People with binge eating disorder compulsively overeat, rapidly consuming thousands of calories in a short period of time. Despite feelings of guilt and shame over these secret binges, they feel unable to control their behavior or stop eating even when uncomfortably full.

Myths and Facts about Eating Disorders

Myth 1: You have to be underweight to have an eating disorder.

Fact: People with eating disorders come in all shapes and sizes. Many individuals with eating disorders are of average weight or are overweight.

Myth 2: Only teenage girls and young women are affected by eating disorders.

Fact: While eating disorders are most common in young women in their teens and early twenties, they are found in men and women of all ages-from children to older adults.

Myth 3: People with eating disorders are vain.

Fact: It's not vanity that drives people with eating disorders to follow extreme diets and obsess over their bodies, but rather an attempt to deal with uncomfortable feelings.

Myth 4: Eating disorders aren't really that dangerous.

Fact: Eating disorders are serious conditions that cause both physical and emotional damage. All eating disorders can lead to irreversible and even life-threatening health problems, such as heart disease, bone loss, stunted growth, infertility, and kidney damage.

Warning signs of an eating disorder

Many people worry about their weight, what they eat, and how they look. This is especially true for teenagers and young adults, who face extra pressure to fit in and look attractive at a time when their bodies are changing. As a result, it can be challenging to tell the difference between an eating disorder and normal self-consciousness, weight concerns, or dieting. Further complicating matters, people with an eating disorder will often go to great lengths to hide the problem. However, there are warning signs you can watch for. And as eating disorders progress, the red flags become easier to spot.

Restricting food or dieting

Making excuses to avoid meals or situations involving food (e.g. they had a big meal earlier, aren't hungry, or have an upset stomach)

Eating only tiny portions or specific low-calorie foods, and often banning entire categories of food such as carbs and dietary fat

Obsessively counting calories, reading food labels, and weighing portions

Developing restrictive food rituals such as eating foods in certain orders, rearranging food on a plate, excessive cutting or chewing.

Taking diet pills, prescription stimulants like Adderall or Ritalin, or even illegal drugs such as amphetamines (speed, crystal, etc.)

Bingeing

Unexplained disappearance of large amounts of food in short periods of time

Lots of empty food packages and wrappers, often hidden at the bottom of the trash

Hoarding and hiding stashes of high-calorie foods such as junk food and sweets

Secrecy and isolation; may eat normally around others, only to binge late at night or in a private spot where they won't be discovered or disturbed

Purging

Disappearing right after a meal or making frequent trips to the bathroom

Showering, bathing, or running water after eating to hide the sound of purging

Using excessive amounts of mouthwash, breath mints, or perfume to disguise the smell of vomiting

Taking laxatives, diuretics, or enemas

Periods of fasting or compulsive, intense exercising, especially after eating

Frequent complaints of sore throat, upset stomach, diarrhea, or constipation

Discolored teeth

Distorted body image and altered appearance

Extreme preoccupation with body or weight (e.g. constant weigh-ins, spending lots of time in front of the mirror inspecting and criticizing their body)

Significant weight loss, rapid weight gain, or constantly fluctuating weight

Frequent comments about feeling fat or overweight, or about a fear of gaining weight

Wearing baggy clothes or multiple layers in an attempt to hide weight

Worried about someone? Speak out!

If you notice the warning signs of an eating disorder in a friend or family member, it's important to speak up. You may be afraid that you're mistaken, or that you'll say the wrong thing, or you might alienate the person. However, it's important that you don't let these worries stop you from voicing your concerns.

People with eating disorders are often afraid to ask for help. Some are struggling just as much as you are to find a way to start a conversation about their problem, while others have such low self-esteem they simply don't feel that they deserve any help. Whatever the case, eating disorders will only get worse without treatment, and the physical and emotional damage can be severe. The sooner you start to help, the better their chances of recovery. While you can't force someone with an eating disorder to get better, having supportive relationships is vital to their recovery. Your love and encouragement can make all the difference.

How to talk to someone about their eating disorder

The decision to make a change is rarely an easy one for someone with an eating disorder. If the eating disorder has left them malnourished, it can distort the way they think-about their body, the world around them, even your motivations for trying to help. Bombarding them with dire warnings about the health consequences of their eating disorder or trying to bully them into eating normally probably won't work. Eating disorders often fill an important role in the person's life-a way to cope with unpleasant emotions-so the allure can be strong. Since you may be met with defensiveness or denial, you'll need to tread carefully when broaching the subject.

Pick a good time. Choose a time when you can speak to the person in private without distractions or constraints. You don't want to have to stop in the middle of the conversation because of other obligations! It's also important to have the conversation at a time of emotional calm. Don't try to have this conversation right after a blow up.

Explain why you're concerned. Be careful to avoid lecturing or criticizing, as this will only make your loved one defensive. Instead, refer to specific situations and behaviors you've noticed, and why they worry you. Your goal at this point is not to offer solutions, but to express your concerns about the person's health, how you much you love them, and your desire to help.

Be prepared for denial and resistance. There's a good chance your loved one may deny having an eating disorder or become angry and defensive. If this happens, try to remain calm, focused, and respectful. Remember that this conversation likely feels very threatening to someone with an eating disorder. Don't take it personally.

Ask if the person has reasons for wanting to change. Even if your loved one lacks the desire to change for themselves, they may want to change for other reasons: to please someone they love, to return to school or work, for example. All that really matters is that they are willing to seek help.

Be patient and supportive. Don't give up if the person shuts you down at first. It may take some time before they're willing to open up and admit to having a problem. The important thing is opening up the lines of communication. If they are willing to talk, listen without judgment, no matter how out of touch they may sound. Make it clear that you care, that you believe in them, and that you'll be there in whatever way they need, whenever they're ready.

What not to do

Avoid ultimatums. Unless you're dealing with an underage child, you can't force someone into treatment. The decision to change must come from them. Ultimatums merely add pressure and promote more secrecy and denial.

Avoid commenting on appearance or weight. People with eating disorders are already overly focused on their bodies. Even assurances that they're not fat play into their preoccupation with being thin. Instead, steer the conversation to their feelings. Why are they afraid of being fat? What do they think they'll achieve by being thin?

Avoid shaming and blaming. Steer clear of accusatory "you" statements like, "You just need to eat!" Or, "You're hurting yourself for no reason." Use "I" statements instead. For example: "I find it hard to watch you wasting away." Or, "I'm scared when I hear you throwing up."

Avoid giving simple solutions. For example, "All you have to do is accept yourself." Eating disorders are complex problems. If it were that easy, your loved one wouldn't be suffering.

Encouraging a person to get help

Aside from offering support, the most important thing you can do for a person with an eating disorder is to encourage treatment. The longer an eating disorder remains undiagnosed and untreated, the harder it is on the body and the more difficult it is to overcome, so urge your loved one to see a doctor right away.

A doctor can assess your loved one's symptoms, provide an accurate diagnosis, and screen for any medical problems that might be involved. The doctor can also determine whether there are any co-existing conditions that require treatment, such as depression, substance abuse, or an anxiety disorder.

If your friend or family member is hesitant to see a doctor, ask them to get a physical just to put your worries to rest. It may help if you offer to make the appointment or go along on the first visit.

Treatments for eating disorders

The right treatment approach for each person depends on their specific symptoms, issues, and strengths, as well as the severity of the disorder. To be most effective, treatment for an eating disorder must address both the physical and psychological aspects of the problem. The goal is to treat any medical or nutritional needs, promote a healthy relationship with food, and teach constructive ways to cope with unpleasant emotions and life's challenges.

A team approach is often best. Those who may be involved in treatment include medical doctors, mental health professionals, and nutritionists. The participation and support of family members also makes a big difference in the success of eating disorder treatment.

Medical treatment. The first priority is to address and stabilize any serious health issues. Hospitalization or residential treatment may be necessary if your loved one is dangerously malnourished, suffering from medical complications, severely depressed or suicidal, or resistant to treatment. Outpatient treatment is an option when the patient is not in immediate medical danger.

Nutritional counseling. Dietitians or nutritionists can help your loved one design balanced meal plans, set dietary goals, and reach or maintain a healthy weight. Counseling may also involve education about proper nutrition.

Therapy. Therapy plays a crucial role in eating disorder treatment. Its goals are to identify the negative thoughts and feelings that are behind the disordered eating behaviors, and to replace them with healthier and less distorted attitudes. Another important goal is to teach the person how to deal with difficult emotions, relationship problems, and stress in a productive, rather than a self-destructive way.

Common types of therapy for eating disorders

Individual therapy. Explores both the eating disorder symptoms and the underlying emotional and interpersonal issues that fuel them. The focus is on increasing self-awareness, challenging dysfunctional beliefs, and improving self-esteem and sense of control.

Family therapy. Examines the family dynamics that may contribute to an eating disorder or interfere with recovery. Often includes some therapy sessions without the patient-a particularly important element when the person with the eating disorder denies having a problem.

Group therapy. Allows people with eating disorders to talk with each other in a supervised setting. Helps to reduce the isolation many people with eating disorders feel. Group members support each other through recovery and share their experiences and advice.

Dealing with eating disorders in the home

As a parent, there are many things you can do to support your child's eating disorder recovery-even if they are still resisting treatment.

Set a positive example. You have more influence than you think. Instead of dieting, eat nutritious, balanced meals. Be mindful about how you talk about your body and your eating. Avoid self-critical remarks or negative comments about others' appearance. Instead, focus on the qualities on the inside that really make a person attractive.

Make mealtimes fun. Try to eat together as a family as often as possible. Even if your child isn't willing to eat the food you've prepared, encourage them to join you at the table. Use this time together to enjoy each other's company, rather than talking about problems. Meals are also a good opportunity to show your child that food is something to be enjoyed rather than feared.

Avoid power struggles over food. Attempts to force your child to eat will only cause conflict and bad feelings and likely lead to more secrecy and lying. That doesn't mean you can't set limits or hold your child accountable for their behavior. But don't act like the food police, constantly monitoring your child's behavior.

Encourage eating with natural consequences. While you can't force healthy eating behaviors, you can encourage them by making the natural consequences of not eating unappealing. For example, if your child won't eat, they can't go to dance class or drive the car because, in their weakened state, it wouldn't be safe. Emphasize that this isn't a punishment, but simply a natural medical consequence.

Do whatever you can to promote self-esteem in your child, with intellectual, athletic, and social endeavors. Give boys and girls the same opportunities and encouragement. A well-rounded sense of self and solid self-esteem are perhaps the best antidotes to disordered eating.

Don't blame yourself. Parents often feel they must take on responsibility for the eating disorder, which is something they truly have no control over. Once you can accept that the eating disorder is not anyone's fault, you can be freed to take action that is honest and not clouded by what you "should" or "could" have done.

Supporting a loved one's recovery

Recovering from an eating disorder takes time. There are no quick fixes or miracle cures, so it's important to have patience and compassion. Don't put unnecessary pressure on your loved one by setting unrealistic goals or demanding progress on your own timetable. Provide hope and encouragement, praise each small step forward, and stay positive through struggles and setbacks.

Learn about eating disorders. The more you know, the better equipped you'll be to help your loved one, avoid pitfalls, and cope with challenges.

Listen without judgment. Show that you care by asking about your loved one's feelings and concerns-and then truly listening. Resist the urge to advise or criticize. Simply let your friend or family member know that they're being heard. Even if you don't understand what they're going through, it's important to validate your loved one's feelings.

Be mindful of triggers. Avoid discussions about food, weight, eating or making negative statements about your own body. But don't be afraid to eat normally in front of someone with an eating disorder. It can help set an example of a healthy relationship with food.

Take care of yourself. Don't become so preoccupied with your loved one's eating disorder that you neglect your own needs. Make sure you have your own support, so you can provide it in turn. Whether that support comes from a trusted friend, a support group, or your own therapist, it's important to have an outlet to talk about your feelings and emotionally recharge. It's also important to schedule time into your day for relaxing and doing things you enjoy.

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Helping Someone with an Eating Disorder - HelpGuide.org

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Does someone you know have an eating disorder? These tips will help you address the issue and offer support.

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Overview of Conduct Disorders in General

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Overview of Conduct Disorders in General

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What Symptoms Should Parents Look for?

There are four basic types of behavior that characterize conduct disorder:

Physical aggression (such as cruelty toward animals, assault or rape).

Violating others' rights (such as theft or vandalism).

Lying or manipulation.

Delinquent behaviors (such as truancy or running away from home).

Conduct disorder is characterized by aggression toward others and a callous disregard for their rights and needs. Adolescents and teens with conduct disorder can find acts of aggression, deceit and coercion to be gratifying. Your child may meet the criteria for conduct disorder if you find them engaging in several of the below behaviors:

Many young people with conduct disorder will have trouble:

Feeling and expressing empathy or remorse.

Showing emotion toward others.

Performing well in the school or community and blaming others for poor performance.

They often misinterpret the actions of others as being hostile or aggressive. They respond by escalating the situation into verbal or physical conflict.

In adolescents and teens, conduct disorder may be associated with other difficulties, including:

In younger children, it can be more of a challenge to distinguish signs of conduct disorder from more typical "acting out".

At times, these same symptoms can be seen in children without the disorder. The difference is frequency, intensity, and duration, as well as to what extent it impacts their functioning. In children with conduct disorder, these behaviors happen much more frequently.

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There are four basic types of behavior that characterize conduct disorder: Physical aggression (such as cruelty toward animals, assault or rape). Violating others' rights (such as theft or vandalism). Lying or manipulation. Delinquent behaviors (such as truancy or running away from home).

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Overview of Oppositional Defiant Disorder

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Overview of Oppositional Defiant Disorder

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Overview

Even the best-behaved children can be difficult and challenging at times. But oppositional defiant disorder (ODD) includes a frequent and ongoing pattern of anger, irritability, arguing and defiance toward parents and other authority figures. ODD also includes being spiteful and seeking revenge, a behavior called vindictiveness.

These emotional and behavioral issues cause serious problems with family life, social activities, school and work. But as a parent, you don't have to try to manage a child with ODD alone. Your health care provider, a mental health professional and a child development expert can help.

Treatment of ODD involves learning skills to help build positive family interactions and to manage problem behaviors. Other therapy, and possibly medicines, may be needed to treat related mental health conditions.

Symptoms

Sometimes it's difficult to recognize the difference between a strong-willed or emotional child and one with oppositional defiant disorder. It's common for children to show oppositional behavior at certain stages of development.

Symptoms of ODD generally begin during preschool years. Sometimes ODD may develop later, but almost always before the early teen years. Oppositional and defiant behaviors are frequent and ongoing. They cause severe problems with relationships, social activities, school and work, for both the child and the family.

Emotional and behavioral symptoms of ODD generally last at least six months. They include angry and irritable mood, argumentative and defiant behavior, and hurtful and revengeful behavior.
Angry and irritable mood

Often and easily loses temper.

Is frequently touchy and easily annoyed by others.

Is often angry and resentful.

Argumentative and defiant behavior

Often argues with adults or people in authority.

Often actively defies or refuses to follow adults' requests or rules.

Often annoys or upsets people on purpose.

Often blames others for their own mistakes or misbehavior.

Hurtful and revengeful behavior

Says mean and hateful things when upset.

Tries to hurt the feelings of others and seeks revenge, also called being vindictive.

Has shown vindictive behavior at least twice in the past six months.

Severity
ODD can be mild, moderate or severe:

Mild. Symptoms occur only in one setting, such as only at home, school, work or with peers.

Moderate. Some symptoms occur in at least two settings.

Severe. Some symptoms occur in three or more settings.

For some children, symptoms may first be seen only at home. But with time, problem behavior also may happen in other settings, such as school, social activities and with friends.

When to see a doctor

Your child isn't likely to see their own behavior as a problem. Instead, your child will probably complain about unreasonable demands or blame others for problems.

If you think your child may have ODD or other problem behavior, or you're concerned about your ability to parent a challenging child, seek help from a child psychologist or a child psychiatrist with expertise in behavior problems. Ask your child's pediatrician or other health care provider for a referral to a mental health provider.

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Causes

There's no known clear cause of oppositional defiant disorder. Causes may include a combination of genetic and environmental factors:

Genetics. A child's natural personality or character - also called temperament - may contribute to developing ODD. Differences in the way nerves and the brain function also may play a role.

Environment. Problems with parenting that may involve a lack of supervision, inconsistent or harsh discipline, or abuse or neglect may contribute to developing ODD.

Risk factors

Oppositional defiant disorder is a complex problem. Possible risk factors for ODD include:

Temperament - a child who has a temperament that includes difficulty managing emotions, such as reacting with strong emotions to situations or having trouble tolerating frustration.

Parenting issues - a child who experiences abuse or neglect, harsh or inconsistent discipline, or a lack of proper supervision.

Other family issues - a child who lives with parent or family relationships that are unstable or has a parent with a mental health condition or substance use disorder.

Environment - problem behaviors that are reinforced through attention from peers and inconsistent discipline from other authority figures, such as teachers.

Complications

Children and teenagers with oppositional defiant disorder may have trouble at home with parents and siblings, in school with teachers, and at work with supervisors and other authority figures. Children and teens with ODD may struggle to make and keep friends and relationships.

ODD also may lead to other problems, such as:

Poor school and work performance.

Antisocial behavior.

Legal problems.

Impulse control problems.

Substance use disorder.

Suicide.

Many children and teens with ODD also have other mental health conditions, such as:

Attention-deficit/hyperactivity disorder (ADHD).

Conduct disorder.

Depression.

Anxiety disorders.

Learning and communication disorders.

Treating these other mental health conditions may help reduce ODD symptoms. It may be difficult to treat ODD if these other conditions are not evaluated and treated appropriately.

Prevention

There's no sure way to prevent oppositional defiant disorder. But positive parenting and early treatment can help improve behavior and prevent the situation from getting worse. The earlier that ODD can be managed, the better.

Treatment can help restore your child's self-esteem and rebuild a positive relationship between you and your child. Your child's relationships with other important adults in their life - such as teachers and care providers - also will benefit from early treatment.

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Oppositional defiant disorder (ODD) - Symptoms and causes

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This childhood mental health condition includes frequent and persistent anger, irritability, arguing, defiance or vindictiveness toward authority.

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Centers for Disease Control and Prevention

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ADHD is one of the most common neurodevelopmental disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active.

Signs and Symptoms

It is normal for children to have trouble focusing and behaving at one time or another. However, children with ADHD do not just grow out of these behaviors. The symptoms continue, can be severe, and can cause difficulty at school, at home, or with friends.

A child with ADHD might:

daydream a lot

forget or lose things a lot

squirm or fidget

talk too much

make careless mistakes or take unnecessary risks

have a hard time resisting temptation

have trouble taking turns

have difficulty getting along with others

Learn more about signs and symptoms
Types

There are three different ways ADHD presents itself, depending on which types of symptoms are strongest in the individual:

Predominantly Inattentive Presentation: It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines.

Predominantly Hyperactive-Impulsive Presentation: The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.

Combined Presentation: Symptoms of the above two types are equally present in the person.

Because symptoms can change over time, the presentation may change over time as well.

Causes of ADHD

Scientists are studying cause(s) and risk factors in an effort to find better ways to manage and reduce the chances of a person having ADHD. The cause(s) and risk factors for ADHD are unknown, but current research shows that genetics plays an important role. Recent studies link genetic factors with ADHD.

In addition to genetics, scientists are studying other possible causes and risk factors including:

Brain injury

Exposure to environmental risks (e.g., lead) during pregnancy or at a young age

Alcohol and tobacco use during pregnancy

Premature delivery

Low birth weight

Research does not support the popularly held views that ADHD is caused by eating too much sugar, watching too much television, parenting, or social and environmental factors such as poverty or family chaos. Of course, many things, including these, might make symptoms worse, especially in certain people. But the evidence is not strong enough to conclude that they are the main causes of ADHD.

Diagnosis

Deciding if a child has ADHD is a process with several steps. There is no single test to diagnose ADHD, and many other problems, like anxiety, depression, sleep problems, and certain types of learning disabilities, can have similar symptoms. One step of the process involves having a medical exam, including hearing and vision tests, to rule out other problems with symptoms like ADHD. Diagnosing ADHD usually includes a checklist for rating ADHD symptoms and taking a history of the child from parents, teachers, and sometimes, the child.
Learn more about the criteria for diagnosing ADHD
Treatments

In most cases, ADHD is best treated with a combination of behavior therapy and medication. For preschool-aged children (4-5 years of age) with ADHD, behavior therapy, particularly training for parents, is recommended as the first line of treatment before medication is tried. What works best can depend on the child and family. Good treatment plans will include close monitoring, follow-ups, and making changes, if needed, along the way.
Learn more about treatments
Managing Symptoms: Staying Healthy

Being healthy is important for all children and can be especially important for children with ADHD. In addition to behavioral therapy and medication, having a healthy lifestyle can make it easier for your child to deal with ADHD symptoms. Here are some healthy behaviors that may help:

Get Help!

If you or your doctor has concerns about ADHD, you can take your child to a specialist such as a child psychologist, child psychiatrist, or developmental pediatrician, or you can contact your local early intervention agency (for children under 3) or public school (for children 3 and older).

The Centers for Disease Control and Prevention (CDC) funds the National Resource Center on ADHD, a program of CHADD - Children and Adults with Attention-Deficit/Hyperactivity Disorder. Their website has links to information for people with ADHD and their families. The National Resource Center operates a call center (1-866-200-8098) with trained staff to answer questions about ADHD.

For more information on services for children with special needs, visit the Center for Parent Information and Resources. To find the Parent Center near you, you can visit this website.

ADHD in Adults

ADHD can last into adulthood. Some adults have ADHD but have never been diagnosed. The symptoms can cause difficulty at work, at home, or with relationships. Symptoms may look different at older ages, for example, hyperactivity may appear as extreme restlessness. Symptoms can become more severe when the demands of adulthood increase. For more information about diagnosis and treatment throughout the lifespan, please visit the websites of the National Resource Center on ADHD and the National Institutes of Mental Health.

More Information

Reference

Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., . . . Wang, Y. (2021). The World Federation of ADHD International Consensus Statement: 208 evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews. doi:10.1016/j.neubiorev.2021.01.022

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ADHD is one of the most common neurobehavioral disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), and in some cases, are overly active.

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“Conduct disorder” refers to a group of behavioral and emotional problems in youngsters. Children and adolescents with this disorder have great difficulty following rules and behaving in a socially acceptable way.

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Diagnosis

To determine a diagnosis and check for related complications, you may have:

A physical exam. Your doctor will try to rule out physical problems that could cause your symptoms.

Lab tests. These may include, for example, a check of your thyroid function or a screening for alcohol and drugs.

A psychological evaluation. A doctor or mental health professional talks to you about your symptoms, thoughts, feelings and behavior patterns. You may be asked to fill out a questionnaire to help answer these questions.

Determining which mental illness you have

Sometimes it's difficult to find out which mental illness may be causing your symptoms. But taking the time and effort to get an accurate diagnosis will help determine the appropriate treatment. The more information you have, the more you will be prepared to work with your mental health professional in understanding what your symptoms may represent.

The defining symptoms for each mental illness are detailed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. This manual is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment.

Classes of mental illness

The main classes of mental illness are:

Neurodevelopmental disorders. This class covers a wide range of problems that usually begin in infancy or childhood, often before the child begins grade school. Examples include autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD) and learning disorders.

Schizophrenia spectrum and other psychotic disorders. Psychotic disorders cause detachment from reality - such as delusions, hallucinations, and disorganized thinking and speech. The most notable example is schizophrenia, although other classes of disorders can be associated with detachment from reality at times.

Bipolar and related disorders. This class includes disorders with alternating episodes of mania - periods of excessive activity, energy and excitement - and depression.

Depressive disorders. These include disorders that affect how you feel emotionally, such as the level of sadness and happiness, and they can disrupt your ability to function. Examples include major depressive disorder and premenstrual dysphoric disorder.

Anxiety disorders. Anxiety is an emotion characterized by the anticipation of future danger or misfortune, along with excessive worrying. It can include behavior aimed at avoiding situations that cause anxiety. This class includes generalized anxiety disorder, panic disorder and phobias.

Obsessive-compulsive and related disorders. These disorders involve preoccupations or obsessions and repetitive thoughts and actions. Examples include obsessive-compulsive disorder, hoarding disorder and hair-pulling disorder (trichotillomania).

Trauma- and stressor-related disorders. These are adjustment disorders in which a person has trouble coping during or after a stressful life event. Examples include post-traumatic stress disorder (PTSD) and acute stress disorder.

Dissociative disorders. These are disorders in which your sense of self is disrupted, such as with dissociative identity disorder and dissociative amnesia.

Somatic symptom and related disorders. A person with one of these disorders may have physical symptoms that cause major emotional distress and problems functioning. There may or may not be another diagnosed medical condition associated with these symptoms, but the reaction to the symptoms is not normal. The disorders include somatic symptom disorder, illness anxiety disorder and factitious disorder.

Feeding and eating disorders. These disorders include disturbances related to eating that impact nutrition and health, such as anorexia nervosa and binge-eating disorder.

Elimination disorders. These disorders relate to the inappropriate elimination of urine or stool by accident or on purpose. Bed-wetting (enuresis) is an example.

Sleep-wake disorders. These are disorders of sleep severe enough to require clinical attention, such as insomnia, sleep apnea and restless legs syndrome.

Sexual dysfunctions. These include disorders of sexual response, such as premature ejaculation and female orgasmic disorder.

Gender dysphoria. This refers to the distress that accompanies a person's stated desire to be another gender.

Disruptive, impulse-control and conduct disorders. These disorders include problems with emotional and behavioral self-control, such as kleptomania or intermittent explosive disorder.

Substance-related and addictive disorders. These include problems associated with the excessive use of alcohol, caffeine, tobacco and drugs. This class also includes gambling disorder.

Neurocognitive disorders. Neurocognitive disorders affect your ability to think and reason. These acquired (rather than developmental) cognitive problems include delirium, as well as neurocognitive disorders due to conditions or diseases such as traumatic brain injury or Alzheimer's disease.

Personality disorders. A personality disorder involves a lasting pattern of emotional instability and unhealthy behavior that causes problems in your life and relationships. Examples include borderline, antisocial and narcissistic personality disorders.

Paraphilic disorders. These disorders include sexual interest that causes personal distress or impairment or causes potential or actual harm to another person. Examples are sexual sadism disorder, voyeuristic disorder and pedophilic disorder.

Other mental disorders. This class includes mental disorders that are due to other medical conditions or that don't meet the full criteria for one of the above disorders.

Treatment

Your treatment depends on the type of mental illness you have, its severity and what works best for you. In many cases, a combination of treatments works best.

If you have a mild mental illness with well-controlled symptoms, treatment from your primary care provider may be sufficient. However, often a team approach is appropriate to make sure all your psychiatric, medical and social needs are met. This is especially important for severe mental illnesses, such as schizophrenia.

Your treatment team

Your treatment team may include your:

Family or primary care doctor

Nurse practitioner

Physician assistant

Psychiatrist, a medical doctor who diagnoses and treats mental illnesses

Psychotherapist, such as a psychologist or a licensed counselor

Pharmacist

Social worker

Family members

Medications

Although psychiatric medications don't cure mental illness, they can often significantly improve symptoms. Psychiatric medications can also help make other treatments, such as psychotherapy, more effective. The best medications for you will depend on your particular situation and how your body responds to the medication.

Some of the most commonly used classes of prescription psychiatric medications include:

Antidepressants. Antidepressants are used to treat depression, anxiety and sometimes other conditions. They can help improve symptoms such as sadness, hopelessness, lack of energy, difficulty concentrating and lack of interest in activities. Antidepressants are not addictive and do not cause dependency.

Anti-anxiety medications. These drugs are used to treat anxiety disorders, such as generalized anxiety disorder or panic disorder. They may also help reduce agitation and insomnia. Long-term anti-anxiety drugs typically are antidepressants that also work for anxiety. Fast-acting anti-anxiety drugs help with short-term relief, but they also have the potential to cause dependency, so ideally they'd be used short term.

Mood-stabilizing medications. Mood stabilizers are most commonly used to treat bipolar disorders, which involves alternating episodes of mania and depression. Sometimes mood stabilizers are used with antidepressants to treat depression.

Antipsychotic medications. Antipsychotic drugs are typically used to treat psychotic disorders, such as schizophrenia. Antipsychotic medications may also be used to treat bipolar disorders or used with antidepressants to treat depression.

Psychotherapy

Psychotherapy, also called talk therapy, involves talking about your condition and related issues with a mental health professional. During psychotherapy, you learn about your condition and your moods, feelings, thoughts and behavior. With the insights and knowledge you gain, you can learn coping and stress management skills.

There are many types of psychotherapy, each with its own approach to improving your mental well-being. Psychotherapy often can be successfully completed in a few months, but in some cases, long-term treatment may be needed. It can take place one-on-one, in a group or with family members.

When choosing a therapist, you should feel comfortable and be confident that he or she is capable of listening and hearing what you have to say. Also, it's important that your therapist understands the life journey that has helped shape who you are and how you live in the world.

Brain-stimulation treatments

Brain-stimulation treatments are sometimes used for depression and other mental health disorders. They're generally reserved for situations in which medications and psychotherapy haven't worked. They include electroconvulsive therapy, repetitive transcranial magnetic stimulation, deep brain stimulation and vagus nerve stimulation.

Make sure you understand all the risks and benefits of any recommended treatment.

Hospital and residential treatment programs

Sometimes mental illness becomes so severe that you need care in a psychiatric hospital. This is generally recommended when you can't care for yourself properly or when you're in immediate danger of harming yourself or someone else.

Options include 24-hour inpatient care, partial or day hospitalization, or residential treatment, which offers a temporary supportive place to live. Another option may be intensive outpatient treatment.

Substance misuse treatment

Problems with substance use commonly occur along with mental illness. Often it interferes with treatment and worsens mental illness. If you can't stop using drugs or alcohol on your own, you need treatment. Talk to your doctor about treatment options.

Participating in your own care

Working together, you and your primary care provider or mental health professional can decide which treatment may be best, depending on your symptoms and their severity, your personal preferences, medication side effects, and other factors. In some cases, a mental illness may be so severe that a doctor or loved one may need to guide your care until you're well enough to participate in decision-making.

Lifestyle and home remedies

In most cases, a mental illness won't get better if you try to treat it on your own without professional care. But you can do some things for yourself that will build on your treatment plan:

Stick to your treatment plan. Don't skip therapy sessions. Even if you're feeling better, don't skip your medications. If you stop, symptoms may come back. And you could have withdrawal-like symptoms if you stop a medication too suddenly. If you have bothersome drug side effects or other problems with treatment, talk to your doctor before making changes.

Avoid alcohol and drug use. Using alcohol or recreational drugs can make it difficult to treat a mental illness. If you're addicted, quitting can be a real challenge. If you can't quit on your own, see your doctor or find a support group to help you.

Stay active. Exercise can help you manage symptoms of depression, stress and anxiety. Physical activity can also counteract the effects of some psychiatric medications that may cause weight gain. Consider walking, swimming, gardening or any form of physical activity that you enjoy. Even light physical activity can make a difference.

Make healthy choices. Maintaining a regular schedule that includes sufficient sleep, healthy eating and regular physical activity are important to your mental health.

Don't make important decisions when your symptoms are severe. Avoid decision-making when you're in the depth of mental illness symptoms, since you may not be thinking clearly.

Determine priorities. You may reduce the impact of your mental illness by managing time and energy. Cut back on obligations when necessary and set reasonable goals. Give yourself permission to do less when symptoms are worse. You may find it helpful to make a list of daily tasks or use a planner to structure your time and stay organized.

Learn to adopt a positive attitude. Focusing on the positive things in your life can make your life better and may even improve your health. Try to accept changes when they occur, and keep problems in perspective. Stress management techniques, including relaxation methods, may help.

Coping and support

Coping with a mental illness is challenging. Talk to your doctor or therapist about improving your coping skills, and consider these tips:

Learn about your mental illness. Your doctor or therapist can provide you with information or may recommend classes, books or websites. Include your family, too - this can help the people who care about you understand what you're going through and learn how they can help.

Join a support group. Connecting with others facing similar challenges may help you cope. Support groups for mental illness are available in many communities and online. One good place to start is the National Alliance on Mental Illness.

Stay connected with friends and family. Try to participate in social activities, and get together with family or friends regularly. Ask for help when you need it, and be upfront with your loved ones about how you're doing.

Keep a journal. Or jot down brief thoughts or record symptoms on a smartphone app. Keeping track of your personal life and sharing information with your therapist can help you identify what triggers or improves your symptoms. It's also a healthy way to explore and express pain, anger, fear and other emotions.

Preparing for your appointment

Whether you schedule an appointment with your primary care provider to talk about mental health concerns or you're referred to a mental health professional, such as a psychiatrist or psychologist, take steps to prepare for your appointment.

If possible, take a family member or friend along. Someone who has known you for a long time may be able to share important information, with your permission.

What you can do

Before your appointment, make a list of:

Any symptoms you or people close to you have noticed, and for how long

Key personal information, including traumatic events in your past and any current, major stressors

Your medical information, including other physical or mental health conditions

Any medications, vitamins, herbal products or other supplements you take, and their dosages

Questions to ask your doctor or mental health professional

Questions to ask may include:

What type of mental illness might I have?

Why can't I get over mental illness on my own?

How do you treat my type of mental illness?

Will talk therapy help?

Are there medications that might help?

How long will treatment take?

What can I do to help myself?

Do you have any brochures or other printed material that I can have?

What websites do you recommend?

Don't hesitate to ask any other questions during your appointment.

What to expect from your doctor

During your appointment, your doctor or mental health professional is likely to ask you questions about your mood, thoughts and behavior, such as:

When did you first notice symptoms?

How is your daily life affected by your symptoms?

What treatment, if any, have you had for mental illness?

What have you tried on your own to feel better or control your symptoms?

What things make you feel worse?

Have family members or friends commented on your mood or behavior?

Do you have blood relatives with a mental illness?

What do you hope to gain from treatment?

What medications or over-the-counter herbs and supplements do you take?

Do you drink alcohol or use recreational drugs?

Your doctor or mental health professional will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your time with the doctor.

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A wide range of mental health conditions affect mood, thinking and behavior and can make you miserable and cause problems in daily life.

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Verified by Psychology Today

A brief psychotic disorder is an uncommon psychiatric condition characterized by sudden and temporary periods of psychotic behavior, such as delusions, hallucinations, and confusion. Symptoms can endure for only one day or for as long as one month, but may be severe enough to put the person at increased risk of violent behavior or suicide. A majority of cases present for the first time when an individual is in their 20s or 30s, although onset can occur at any age. Brief psychotic disorder is differentiated from other disorders in which psychosis occurs by its limited duration, and it is not triggered by drugs or alcohol abuse. In most cases brief psychotic disorder does not indicate the presence of a chronic mental health condition.

Symptoms

According to the DSM-5, symptoms of brief psychotic disorder may include:

Delusions and hallucinations

Sudden and extreme mood changes

Nonsensical or disordered speech

Disorganized behavior

Catatonia

Women are more likely than men to develop brief psychotic disorder, especially postpartum. The DSM-5 classifies one subtype of brief psychotic disorder as psychosis with onset within one month of giving birth. Most people who develop brief psychotic disorder experience only one episode and are able to resume all activities with no permanent symptoms or impairment. People with certain personality disorders have an elevated risk of experiencing a brief psychotic episode, as are those who have experienced trauma or severe stress. It is important to understand that the prognosis for brief psychotic disorder is generally good. However, an initial psychotic episode may be the first sign of a chronic mental health condition such as schizoaffective disorder, schizophrenia, or a mood disorder with psychotic symptoms. The diagnosis of brief psychotic disorder is generally reevaluated if symptoms persist for more than one month.

Causes

The cause of brief psychotic disorder is unclear, but major stress or trauma - such as the death of a loved one, assault, or natural disaster - can trigger an episode. As with other disorders on the psychotic spectrum, there may be a genetic, biologic, environmental, or neurological basis for this episode. Neurological abnormalities have been found in people with psychotic disorders; some appear to be present before symptoms first appear, while other abnormalities have been recorded after the onset of symptoms. Brief psychotic disorder tends to run in families.

Treatment

Generally, a medical or psychiatric professional will interview the person to rule out any other physical or mental health condition that exists simultaneously or could be causing the symptoms. Antipsychotic medications and, if necessary, antidepressants may be prescribed to help manage symptoms, and the person may need to be supervised at all times to ensure they don't harm themselves or others. Short-term psychotherapy can help a person understand and recover from brief psychotic disorder, manage their medications, and learn to cope with stress. Those who fail to seek treatment after a first psychotic episode are more likely to see a future recurrence of brief psychotic disorder or to subsequently be diagnosed with a chronic disorder on the psychotic spectrum.

References

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

MedlinePlus

Pantelis C, Velakoulis D, McGorry PD, et al. Neuroanatomical abnormalities before and after onset of psychosis: a cross-sectional and longitudinal MRI comparison. Lancet. Jan 2003;361(9354): 281-288.

Fusar-Poli P, Cappucciati M, Bonoldi I, et al. Prognosis of brief psychotic episodes: A meta-analysis. First published online March 2016. JAMA Psychiatry.

Last reviewed 04/13/2017

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A brief psychotic disorder is an uncommon psychiatric condition characterized by sudden and temporary periods of psychotic behavior, such as delusions, hallucinations, and confusion. Symptoms can endure for only one day or for as long as one month, but may be severe enough to put the person at increased risk of violent behavior or suicide.

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This severe mental disorder can result in hallucinations, delusions, and extremely disordered thinking and behavior that interfere with daily living.

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Tips for Dealing with Symptoms of Psychosis

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Tips for Dealing with Symptoms of Psychosis

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Overview of Anxiety Disorders in General

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Overview of Anxiety Disorders in General

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Overview

Experiencing occasional anxiety is a normal part of life. However, people with anxiety disorders frequently have intense, excessive and persistent worry and fear about everyday situations. Often, anxiety disorders involve repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks).

These feelings of anxiety and panic interfere with daily activities, are difficult to control, are out of proportion to the actual danger and can last a long time. You may avoid places or situations to prevent these feelings. Symptoms may start during childhood or the teen years and continue into adulthood.

Examples of anxiety disorders include generalized anxiety disorder, social anxiety disorder (social phobia), specific phobias and separation anxiety disorder. You can have more than one anxiety disorder. Sometimes anxiety results from a medical condition that needs treatment.

Whatever form of anxiety you have, treatment can help.

Symptoms

Common anxiety signs and symptoms include:

Feeling nervous, restless or tense

Having a sense of impending danger, panic or doom

Having an increased heart rate

Breathing rapidly (hyperventilation)

Sweating

Trembling

Feeling weak or tired

Trouble concentrating or thinking about anything other than the present worry

Having trouble sleeping

Experiencing gastrointestinal (GI) problems

Having difficulty controlling worry

Having the urge to avoid things that trigger anxiety

Several types of anxiety disorders exist:

Agoraphobia (ag-uh-ruh-FOE-be-uh) is a type of anxiety disorder in which you fear and often avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed.

Anxiety disorder due to a medical condition includes symptoms of intense anxiety or panic that are directly caused by a physical health problem.

Generalized anxiety disorder includes persistent and excessive anxiety and worry about activities or events - even ordinary, routine issues. The worry is out of proportion to the actual circumstance, is difficult to control and affects how you feel physically. It often occurs along with other anxiety disorders or depression.

Panic disorder involves repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks). You may have feelings of impending doom, shortness of breath, chest pain, or a rapid, fluttering or pounding heart (heart palpitations). These panic attacks may lead to worrying about them happening again or avoiding situations in which they've occurred.

Selective mutism is a consistent failure of children to speak in certain situations, such as school, even when they can speak in other situations, such as at home with close family members. This can interfere with school, work and social functioning.

Separation anxiety disorder is a childhood disorder characterized by anxiety that's excessive for the child's developmental level and related to separation from parents or others who have parental roles.

Social anxiety disorder (social phobia) involves high levels of anxiety, fear and avoidance of social situations due to feelings of embarrassment, self-consciousness and concern about being judged or viewed negatively by others.

Specific phobias are characterized by major anxiety when you're exposed to a specific object or situation and a desire to avoid it. Phobias provoke panic attacks in some people.

Substance-induced anxiety disorder is characterized by symptoms of intense anxiety or panic that are a direct result of misusing drugs, taking medications, being exposed to a toxic substance or withdrawal from drugs.

Other specified anxiety disorder and unspecified anxiety disorder are terms for anxiety or phobias that don't meet the exact criteria for any other anxiety disorders but are significant enough to be distressing and disruptive.

When to see a doctor

See your doctor if:

You feel like you're worrying too much and it's interfering with your work, relationships or other parts of your life

Your fear, worry or anxiety is upsetting to you and difficult to control

You feel depressed, have trouble with alcohol or drug use, or have other mental health concerns along with anxiety

You think your anxiety could be linked to a physical health problem

You have suicidal thoughts or behaviors - if this is the case, seek emergency treatment immediately

Your worries may not go away on their own, and they may get worse over time if you don't seek help. See your doctor or a mental health provider before your anxiety gets worse. It's easier to treat if you get help early.

Causes

The causes of anxiety disorders aren't fully understood. Life experiences such as traumatic events appear to trigger anxiety disorders in people who are already prone to anxiety. Inherited traits also can be a factor.

Medical causes

For some people, anxiety may be linked to an underlying health issue. In some cases, anxiety signs and symptoms are the first indicators of a medical illness. If your doctor suspects your anxiety may have a medical cause, he or she may order tests to look for signs of a problem.

Examples of medical problems that can be linked to anxiety include:

Heart disease

Diabetes

Thyroid problems, such as hyperthyroidism

Respiratory disorders, such as chronic obstructive pulmonary disease (COPD) and asthma

Drug misuse or withdrawal

Withdrawal from alcohol, anti-anxiety medications (benzodiazepines) or other medications

Chronic pain or irritable bowel syndrome

Rare tumors that produce certain fight-or-flight hormones

Sometimes anxiety can be a side effect of certain medications.

It's possible that your anxiety may be due to an underlying medical condition if:

You don't have any blood relatives (such as a parent or sibling) with an anxiety disorder

You didn't have an anxiety disorder as a child

You don't avoid certain things or situations because of anxiety

You have a sudden occurrence of anxiety that seems unrelated to life events and you didn't have a previous history of anxiety

Risk factors

These factors may increase your risk of developing an anxiety disorder:

Trauma. Children who endured abuse or trauma or witnessed traumatic events are at higher risk of developing an anxiety disorder at some point in life. Adults who experience a traumatic event also can develop anxiety disorders.

Stress due to an illness. Having a health condition or serious illness can cause significant worry about issues such as your treatment and your future.

Stress buildup. A big event or a buildup of smaller stressful life situations may trigger excessive anxiety - for example, a death in the family, work stress or ongoing worry about finances.

Personality. People with certain personality types are more prone to anxiety disorders than others are.

Other mental health disorders. People with other mental health disorders, such as depression, often also have an anxiety disorder.

Having blood relatives with an anxiety disorder. Anxiety disorders can run in families.

Drugs or alcohol. Drug or alcohol use or misuse or withdrawal can cause or worsen anxiety.

Complications

Having an anxiety disorder does more than make you worry. It can also lead to, or worsen, other mental and physical conditions, such as:

Depression (which often occurs with an anxiety disorder) or other mental health disorders

Substance misuse

Trouble sleeping (insomnia)

Digestive or bowel problems

Headaches and chronic pain

Social isolation

Problems functioning at school or work

Poor quality of life

Suicide

Prevention

There's no way to predict for certain what will cause someone to develop an anxiety disorder, but you can take steps to reduce the impact of symptoms if you're anxious:

Get help early. Anxiety, like many other mental health conditions, can be harder to treat if you wait.

Stay active. Participate in activities that you enjoy and that make you feel good about yourself. Enjoy social interaction and caring relationships, which can lessen your worries.

Avoid alcohol or drug use. Alcohol and drug use can cause or worsen anxiety. If you're addicted to any of these substances, quitting can make you anxious. If you can't quit on your own, see your doctor or find a support group to help you.

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Learn the symptoms of this mental health condition, and ways to manage worry and fear that interfere with your daily activities.

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Info About Anxiety in Children & Adolescents

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Info About Anxiety in Children & Adolescents

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Everyone experiences anxiety. It is a natural and important emotion, signaling through stirrings of worry, fearfulness, and alarm that danger or a sudden, threatening change is near. Yet sometimes anxiety becomes an exaggerated, unhealthy response.

Given the array of changes and uncertainties facing a normal teenager, anxiety often hums along like background noise. For some teenagers, anxiety becomes a chronic, highpitched state, interfering with their ability to attend school and to perform up to their academic potential. Participating in extracurricular activities, making and keeping friends, and maintaining a supportive, flexible relationship within the family become difficult. Sometimes anxiety is limited to generalized, free-floating feelings of uneasiness. At other times, it develops into panic attacks and phobias.

Identifying the Signs
Anxiety disorders vary from teenager to teenager. Symptoms generally include excessive fears and worries, feelings of inner restlessness, and a tendency to be excessively wary and vigilant. Even in the absence of an actual threat, some teenagers describe feelings of continual nervousness, restlessness, or extreme stress.

In a social setting, anxious teenagers may appear dependent, withdrawn, or uneasy. They seem either overly restrained or overly emotional. They may be preoccupied with worries about losing control or unrealistic concerns about social competence.

Teenagers who suffer from excessive anxiety regularly experience a range of physical symptoms as well. They may complain about muscle tension and cramps, stomachaches, headaches, pain in the limbs and back, fatigue, or discomforts associated with pubertal changes. They may blotch, flush, sweat, hyperventilate, tremble, and startle easily.

Anxiety during adolescence typically centers on changes in the way the adolescent's body looks and feels, social acceptance, and conflicts about independence. When flooded with anxiety, adolescents may appear extremely shy. They may avoid their usual activities or refuse to engage in new experiences. They may protest whenever they are apart from friends. Or in an attempt to diminish or deny their fears and worries, they may engage in risky behaviors, drug experimentation, or impulsive sexual behavior.

Panic Disorder More common in girls than boys, panic disorder emerges in adolescence usually between the ages of fifteen and nineteen. Feelings of intense panic may arise without any noticeable cause or they may be triggered by specific situations, in which case they are called panic attacks. A panic attack is an abrupt episode of severe anxiety with accompanying emotional and physical symptoms.

During a panic attack, the youngster may feel overwhelmed by an intense fear or discomfort, a sense of impending doom, the fear he's going crazy, or sensations of unreality. Accompanying the emotional symptoms may be shortness of breath, sweating, choking, chest pains, nausea, dizziness, and numbness or tingling in his extremities. During an attack, some teens may feel they're dying or can't think. Following a panic attack, many youngsters worry that they will have other attacks and try to avoid situations that they believe may trigger them. Because of this fearful anticipation, the teen may begin to avoid normal activities and routines.

Phobias Many fears of younger children are mild, passing, and considered within the range of normal development. Some teenagers develop exaggerated and usually inexplicable fears called phobias that center on specific objects or situations. These intense fears can limit a teenager's activities. The fear generated by a phobia is excessive and not a rational response to a situation. The objects of a phobia usually change as a child gets older. While very young children may be preoccupied with the dark, monsters, or actual dangers, adolescents' phobic fears tend to involve school and social performance.

Several studies have revealed an increase in school avoidance in middle-school or junior-high years. With school avoidance, excessive worries about performance or social pressures at school may be at the root of the reluctance to attend school regularly. This leads to a cycle of anxiety, physical complaints, and school avoidance. The cycle escalates with the worsening of physical complaints such as stomachaches, headaches, and menstrual cramps. Visits to the doctor generally fail to uncover general medical explanations. The longer a teenager stays out of school, the harder it becomes for him to overcome his fear and anxiety and return to school. He feels increasingly isolated from school activities and different from other kids.

Some youngsters are naturally more timid than others, As their bodies, voices, and emotions change during adolescence, they may feel even more self-conscious. Despite initial feelings of uncertainty, most teens are able to join in if given time to observe and warm up. In extreme cases, called social phobia, the adolescent becomes very withdrawn, and though he wants to take part in social activities, he's unable to overcome intense self-doubt and worry. Gripped by excessive or unreasonable anxiety when faced with entering a new or unfamiliar social situation, the adolescent with social phobia becomes captive to unrelenting fears of other people's judgment or expectations. He may deal with his social discomfort by fretting about his health, appearance, or overall competence. Alternatively, he may behave in a clowning or boisterous fashion or consume alcohol to deal with the anxiety.

Because so much of a teenager's social life gets played out in school, social phobia may overlap with and be hard to distinguish from school avoidance. Some teens with social phobia may try to sidestep their anxious feelings altogether by refusing to attend or participate in school, Classroom and academic performance falls off, involvement in social and extracurricular activities dwindles, and, as a consequence, self-esteem declines.

Some teens may experience such a high level of anxiety that they cannot leave the house. This disorder, agoraphobia, seems to stem from feelings about being away from parents and fears of being away from home rather than fear of the world. In fact, a number of children who demonstrate severe separation anxiety in early childhood go on to develop agoraphobia as adolescents and adults.

Causes and Consequences
Most researchers believe that a predisposition towards timidity and nervousness is inborn. If one parent is naturally anxious, there's a good chance that their child will also have anxious tendencies. At the same time, a parent's own uneasiness is often communicated to the child, compounding the child's natural sensitivity. A cycle of increasing uneasiness may then be established. By the time this child reaches adolescence, his characteristic way of experiencing and relating to his world is tinged with anxiety. Some research suggests that children who are easily agitated or upset never learned to soothe themselves earlier in life.

In many cases, adolescent anxiety disorders may have begun earlier as separation anxiety, the tendency to become flooded with fearfulness whenever separated from home or from those to whom the child is attached, usually a parent. Adolescents can also have separation disorders. These teens may deny anxiety about separation, yet it may be reflected in their reluctance to leave home and resistance to being drawn into independent activity. Separation anxiety is often behind a teen's refusal to attend or remain at school.

School avoidance can follow a significant change at school, such as the transition into middle school or junior high. It may also be triggered by something unrelated to school, such as a divorce, illness, or a death in the family. Some youngsters become fearful about gang activities or the lack of safety in school.

A worried teenager performs less well in school, sports, and social interactions. Too much worry can also result in a teenager's failing to achieve to his potential. A teen who experiences a great deal of anxiety may be overly conforming, perfectionistic, and unsure of himself. In attempting to gain approval or avoid disapproval, he may redo tasks or procrastinate. The anxious youngster often seeks excessive reassurance about his identity and whether be is good enough.

Some teenagers with anxiety disorders can also develop mood disorders or eating disorders. Some teenagers who experience persistent anxiety may also develop suicidal feelings or engage in self-destructive behaviors; these situations require immediate attention and treatment. Anxious teens may also use alcohol and drugs to self-medicate or self-sootheor develop rituals in an effort to reduce or prevent anxiety.

How to Respond
If your teenager is willing to talk about his fears and anxieties, listen carefully and respectfully. Without discounting his feelings, help him understand that increased feelings of uneasiness about his body, performance, and peer acceptance and a general uncertainty are all natural parts of adolescence.

By helping him trace his anxiety to specific situations and experiences, you may help him reduce the overwhelming nature of his feelings. Reassure him that, although his concerns are real, in all likelihood he will be able to handle them and that as he gets older, he will develop different techniques to be better able to deal with stress and anxiety.

Remind him of other times when he was initially afraid but still managed to enter into new situations, such as junior high school or camp. Praise him when he takes part in spite of his uneasiness. Point out that you are proud of his ability to act in the face of considerable anxiety. Remember, your teenager may not always be comfortable talking about feelings that he views as signs of weakness. While it may seem at the moment as though he's not listening, later he may be soothed by your attempts to help.

If fearfulness begins to take over your teenager's life and limit his activities, or if the anxiety lasts over six months, seek professional advice. His doctor or teacher will be able to recommend a child and adolescent psychiatrist or other professional specializing in treating adolescents.

Managing anxiety disorders - as with any adolescent emotional disturbance - usually requires a combination of treatment interventions. The most effective plan must be individualized to the teenager and his family. While these disorders can cause considerable distress and disruption to the teen's life, the overall prognosis is good.

Treatment for an anxiety disorder begins with an evaluation of symptoms, family and social context, and the extent of interference or impairment to the teen. Parents, as well as the teenager, should be included in this process. School records and personnel may be consulted to identify how the teen's performance and function in school has been affected by the disorder.

The evaluating clinician will also consider any underlying physical illnesses or diseases, such as diabetes, that could be causing the anxiety symptoms. Medications that might cause anxiety (such as some drugs used in treating asthma) will be reviewed. Since large amounts of caffeine, in coffee or soft drinks, can cause agitation, a clinician might look at the youngster's diet as well. Other biological, psychological, family, and social factors that might predispose the youngster to undue anxiety will also be considered.

If a teenager refuses to go to school, a clinician will explore other possible explanations before labeling it school avoidance. Perhaps the teen is being threatened or harassed, is depressed, or has an unrecognized learning disability. He may also be skipping school in order to be with friends, not from anxiety about performance or separation.

If the teenager has engaged in suicidal or self-endangering behavior, is trying to self medicate through alcohol or drug use, or is seriously depressed, these problems should be addressed immediately. In such cases, hospitalization may be recommended to protect the youngster.

In most cases, treatment of anxiety disorders focuses on reducing the symptoms of anxiety, relieving distress, preventing complications associated with the disorder, and minimizing the effects on the teen's social, school, and developmental progress. If the problem manifests in school avoidance, the initial goal will be to get the youngster back to school as soon as possible.

Cognitive-Behavioral Therapy In many cases, cognitive-behavioral psychotherapy techniques are effective in addressing adolescent anxiety disorders. Such approaches help the teenager examine his anxiety, anticipate situations in which it is likely to occur, and understand its effects. This can help a youngster recognize the exaggerated nature of his fears and develop a corrective approach to the problem. Moreover, cognitive-behavioral therapy tends to be specific to the anxiety problem, and the teen actively participates, which usually enhances the youngster's understanding.

Other Therapies In some instances, long-term psychotherapy, and family therapy may also be recommended.

Medications When symptoms are severe, a combination of therapy and medication may be used. Antidepressant medications, such as nortriptyline (Pamelor), imipramine (Tofranil), doxepin (Sinequan), paroxetine (Paxil), sertraline (Zoloft), or fluoxetine (Prozac), or anxiety-reducing drugs, such as alprazolam (Xanax), clonazepam (Klonopin), or lorazepam (Ativan) may be prescribed in combination with cognitive or other psychotherapy. When tricyclic antidepressant medications such as imipramine are pre-scribed, your teen's physician may want to monitor for potential side effects by conducting periodic physical exams and occasional electrocardiograms (EKGs).
Click here to order Your Adolescent from Harper Collins
See also;
Anxiety Disorders Resource Center
Facts for Families #47, The Anxious Child
Glossary of Symptoms and Illnesses; Anxiety
AACAP's Practice Parameter for the Assessment and Treatment of Children and Adolescents with Anxiety Disorders

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Your Adolescent - Anxiety and Avoidant Disorders

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Everyone experiences anxiety. It is a natural and important emotion, signaling through stirrings of worry, fearfulness, and alarm that danger or a sudden, threatening change is near. Yet sometimes anxiety becomes an exaggerated, unhealthy response. Given the array of changes and uncertainties facing a normal teenager, anxiety often hums along like background noise.

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Resources for Generalized Anxiety Disorder

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Resources for Generalized Anxiety Disorder

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What is generalized anxiety disorder?

People who have generalized anxiety disorder, or GAD, worry uncontrollably about common occurrences and situations. It's also sometimes known as chronic anxiety neurosis.

GAD is different from normal feelings of anxiousness. It's common to feel anxious about the things happening in your life - such as your finances - every once in awhile. A person who has GAD may worry uncontrollably about their finances several times per day for months on end. This can happen even when there isn't a reason to worry. The person is often aware that there is no reason for them to worry.

Sometimes people with this condition just worry, but they are unable to say what they are worried about. They report feelings that something bad may happen or may report that they just can't calm themselves.

This excessive, unrealistic worry can be frightening and can interfere with relationships and daily activities.

Symptoms of GAD include:

difficulty concentrating

difficulty sleeping

irritability

fatigue and exhaustion

muscle tension

repeated stomachaches or diarrhea

sweaty palms

shaking

rapid heartbeat

neurological symptoms, such as numbness or tingling in different parts of the body

Distinguishing GAD from other mental health issues

Anxiety is a common symptom of many mental health conditions, like depression and various phobias. GAD is different from these conditions in several ways.

People with depression may occasionally feel anxious, and people who have a phobia worry about one particular thing. But people with GAD worry about a number of different topics over a long period of time (six months or more), or they may not be able to identify the source of their worry.

Causes of and risk factors for GAD may include:

a family history of anxiety

recent or prolonged exposure to stressful situations, including personal or family illnesses

excessive use of caffeine or tobacco, which can make existing anxiety worse

childhood abuse

According to the Mayo Clinic, women are twice as likely as men to experience GAD.

GAD is diagnosed with a mental health screening that your primary care provider can perform. They will ask you questions about your symptoms and how long you've had them. They can refer you to a mental health specialist, such as a psychologist or psychiatrist.

Your doctor may also do medical tests to determine whether there is an underlying illness or substance abuse problem causing your symptoms. Anxiety has been linked to:

gastroesophageal reflux disease (GERD)

thyroid disorders

heart disease

menopause

If your primary care provider suspects that a medical condition or substance abuse problem is causing anxiety, they may perform more tests. These may include:

blood tests, to check hormone levels that may indicate a thyroid disorder

urine tests, to check for substance abuse

gastric reflux tests, such as an X-ray of your digestive system or an endoscopy procedure to look at your esophagus, to check for GERD

X-rays and stress tests, to check for heart conditions

Cognitive behavioral therapy

This treatment involves meeting regularly to talk with a mental health professional. The goal is to change your thinking and behaviors. This approach has been successful in creating permanent change in many people with anxiety. It's considered first-line treatment for anxiety disorders in people who are pregnant. Others have found that the benefits of cognitive behavioral therapy have provided long-term anxiety relief.

In therapy sessions, you will learn how to recognize and control your anxious thoughts. Your therapist will also teach you how to calm yourself when upsetting thoughts arise.

Doctors often prescribe medications along with therapy to treat GAD.

Medication

If your doctor recommends drugs, they will most likely create a short-term medication plan and a long-term medication plan.

Short-term medications relax some of the physical symptoms of anxiety, such as muscle tension and stomach cramping. These are called anti-anxiety medications. Some common anti-anxiety medications are:

alprazolam (Xanax)

clonazepam (Klonopin)

lorazepam (Ativan)

Anti-anxiety drugs aren't meant to be taken for long periods of time, as they have a high risk of dependence and abuse.

Medications called antidepressants work well for long-term treatment. Some common antidepressants are:

buspirone (Buspar)

citalopram (Celexa)

escitalopram (Lexapro)

fluoxetine (Prozac, Prozac Weekly, Sarafem)

fluvoxamine (Luvox, Luvox CR)

paroxetine (Paxil, Paxil CR, Pexeva)

sertraline (Zoloft)

venlafaxine (Effexor XR)

desvenlafaxine (Pristiq)

duloxetine (Cymbalta)

These medications can take a few weeks to start working. They can also have side effects, such as dry mouth, nausea, and diarrhea. These symptoms bother some people so much that they stop taking these medications.

There is also a very low risk of increased suicidal thoughts in young adults at the beginning of treatment with antidepressants. Stay in close contact with your prescriber if you're taking antidepressants. Make sure you report any mood or thought changes that worry you.

Your doctor may prescribe both an anti-anxiety medication and an antidepressant. If so, you'll probably only take the anti-anxiety medication for a few weeks until your antidepressant starts working, or on an as-needed basis.

Many people can find relief by adopting certain lifestyle habits. These may include:

regular exercise, a healthy diet, and plenty of sleep

yoga and meditation

avoiding stimulants, such as coffee and some over-the-counter medications, such as diet pills and caffeine pills

talking with a trusted friend, spouse, or family member about fears and worries

Alcohol and anxiety

Drinking alcohol can make you feel less anxious almost immediately. This is why many people who suffer from anxiety turn to drinking alcohol to feel better.

However, it's important to remember that alcohol can have a negative effect on your mood. Within a few hours after drinking, or the day after, you may feel more irritability or depression. Alcohol can also interfere with the medications used to treat anxiety. Some medication and alcohol combinations can be fatal.

If you find that your drinking is interfering with your daily activities, talk to your primary care provider. You can also find free support to stop drinking through Alcoholics Anonymous (AA).

Most people can manage GAD with a combination of therapy, medication, and lifestyle changes. Talk to your doctor if you're concerned about how much you worry. They can refer you to a mental health specialist.

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What's Generalized Anxiety Disorder (GAD) and How Do I Treat It?

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What is generalized anxiety disorder? People who have generalized anxiety disorder, or GAD, worry uncontrollably about common occurrences and situations. It's also sometimes known as chronic anxiety neurosis. GAD is different from normal feelings of anxiousness. It's common to feel anxious about the things happening in your life - such as your finances - every once in awhile.

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National Institute of Mental Health (NIMH)

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Are you afraid of being judged by others? Are you self-conscious in everyday social situations? Do you avoid meeting new people due to fear or anxiety? If you have been feeling this way for at least 6 months and these feelings make it hard for you to do everyday tasks-such as talking to people at work or school-you may have social anxiety disorder.

Social anxiety disorder is an intense, persistent fear of being watched and judged by others. This fear can affect work, school, and other daily activities. It can even make it hard to make and keep friends. The good news is social anxiety disorder is treatable. Learn more about the symptoms of social anxiety disorder and how to find help.

What is social anxiety disorder?

Social anxiety disorder is a common type of anxiety disorder. A person with social anxiety disorder feels symptoms of anxiety or fear in situations where they may be scrutinized, evaluated, or judged by others, such as speaking in public, meeting new people, dating, being on a job interview, answering a question in class, or having to talk to a cashier in a store. Doing everyday things, such as eating or drinking in front of others or using a public restroom, also may cause anxiety or fear due to concerns about being humiliated, judged, and rejected.

The fear that people with social anxiety disorder have in social situations is so intense that they feel it is beyond their control. For some people, this fear may get in the way of going to work, attending school, or doing everyday things. Other people may be able to accomplish these activities but experience a great deal of fear or anxiety when they do. People with social anxiety disorder may worry about engaging in social situations for weeks before they happen. Sometimes, they end up avoiding places or events that cause distress or generate feelings of embarrassment.

Some people with the disorder do not have anxiety related to social interactions but have it during performances instead. They feel symptoms of anxiety in situations such as giving a speech, competing in a sports game, or playing a musical instrument on stage.

Social anxiety disorder usually starts during late childhood and may resemble extreme shyness or avoidance of situations or social interactions. It occurs more frequently in females than in males, and this gender difference is more pronounced in adolescents and young adults. Without treatment, social anxiety disorder can last for many years, or even a lifetime.

What are the signs and symptoms of social anxiety disorder?

When having to perform in front of or be around others, people with social anxiety disorder may:

Blush, sweat, or tremble.

Have a rapid heart rate.

Feel their "mind going blank," or feel sick to their stomach.

Have a rigid body posture, or speak with an overly soft voice.

Find it difficult to make eye contact, be around people they don't know, or talk to people in social situations, even when they want to.

Feel self-consciousness or fear that people will judge them negatively.

Avoid places where there are other people.

What causes social anxiety disorder?

Risk for social anxiety disorder may run in families, but no one knows for sure why some family members have it while others don't. Researchers have found that several parts of the brain are involved in fear and anxiety and that genetics influences how these areas function. By studying how the brain and body interact in people with social anxiety disorder, researchers may be able to create more targeted treatments. In addition, researchers are looking at the ways stress and environmental factors play a role in the disorder.

How is social anxiety disorder treated?

If you're concerned you may have symptoms of social anxiety disorder, talk to a health care provider. After discussing your history, a health care provider may conduct a physical exam to ensure that an unrelated physical problem is not causing your symptoms. A health care provider may refer you to a mental health professional, such as a psychiatrist, psychologist, or clinical social worker. The first step to effective treatment is to get a diagnosis, usually from a mental health professional.

Social anxiety disorder is generally treated with psychotherapy (sometimes called "talk therapy"), medication, or both. Speak with a health care provider about the best treatment for you.

Psychotherapy

Cognitive behavioral therapy (CBT), a research-supported type of psychotherapy, is commonly used to treat social anxiety disorder. CBT teaches you different ways of thinking, behaving, and reacting to situations to help you feel less anxious and fearful. CBT also can help you learn and practice social skills, which is very important for treating social anxiety disorder. CBT has been well studied and is the gold standard for psychotherapy.

Exposure therapy is a CBT method that focuses on progressively confronting the fears underlying an anxiety disorder to help you engage in activities you have been avoiding. Exposure therapy is sometimes used along with relaxation exercises. CBT delivered in a group therapy format also can offer unique benefits for social anxiety disorder.

Another treatment option for social anxiety disorder is acceptance and commitment therapy (ACT). ACT takes a different approach than CBT to negative thoughts and uses strategies such as mindfulness and goal setting to reduce your discomfort and anxiety. Compared to CBT, ACT is a newer form of psychotherapy treatment, so less data are available on its effectiveness. However, different therapies work for different types of people, so it can be helpful to discuss what form of therapy may be right for you with a mental health professional.

For more information on psychotherapy, visit the National Institute of Mental Health (NIMH) psychotherapies webpage.

Medication

Health care providers may prescribe medication to treat social anxiety disorder. Different types of medication can be effective in treating this disorder, including:

Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)

Beta-blockers

Anti-anxiety medications, such as benzodiazepines

SSRI and SNRI antidepressants are commonly used to treat depression, but they also can help treat the symptoms of social anxiety disorder. They may take several weeks to start working. Antidepressants may also cause side effects, such as headaches, nausea, or difficulty sleeping. These side effects are usually not severe, especially if the dose starts off low and is increased slowly over time. Talk to your health care provider about any side effects that you may experience.

Beta-blockers can help control some of the physical symptoms of social anxiety disorder, such as rapid heart rate, sweating, and tremors. Beta-blockers are commonly the medication of choice for the "performance anxiety" type of social anxiety disorder.

Benzodiazepines, which are anti-anxiety sedative medications, are powerful and begin working right away to reduce anxious feelings. These medications can be very effective in rapidly decreasing anxiety, but some people build up a tolerance to them and need higher and higher doses to get the same effect. Some people even become dependent on them. Therefore, a health care provider may prescribe them only for brief periods of time if you need them.

Both psychotherapy and medication can take some time to work. Many people try more than one medication before finding the best one for them. A health care provider can work with you to find the best medication, dose, and duration of treatment for you. People with social anxiety disorder usually obtain the best results with a combination of medication and CBT or other psychotherapies.

For basic information about these and other mental health medications, visit NIMH's Mental Health Medications webpage. Visit the U.S. Food and Drug Administration (FDA) website for the latest warnings, patient medication guides, and information on newly approved medications.

Support Groups

Many people with social anxiety find support groups helpful. In a group of people who all have social anxiety disorder, you can receive unbiased, honest feedback about how others in the group see you. This way, you can learn that your thoughts about judgment and rejection are not true or are distorted. You also can learn how others with social anxiety disorder approach and overcome the fear of social situations.

Support groups are available both in person and online. However, any advice you receive from a support group member should be used cautiously and does not replace treatment recommendations from a health care provider.

Both psychotherapy and medication can take some time to work. A healthy lifestyle also can help combat anxiety. Make sure to get enough sleep and exercise, eat a healthy diet, and turn to family and friends who you trust for support. To learn more ways to take care of your mental health, visit NIMH's Caring for Your Mental Health webpage.

How can I support myself and others with social anxiety disorder?

Educate Yourself

A good way to help yourself or a loved one who may be struggling with social anxiety disorder is to seek information. Research the warning signs, learn about treatment options, and keep up to date with current research.

Communicate

If you are experiencing social anxiety disorder symptoms, have an honest conversation about how you're feeling with someone you trust. If you think that a friend or family member may be struggling with social anxiety disorder, set aside a time to talk with them to express your concern and reassure them of your support.

Know When to Seek Help

If your anxiety, or the anxiety of a loved one, starts to cause problems in everyday life-such as avoiding social situations at school, at work, or with friends and family-it's time to seek professional help. Talk to a health care provider about your mental health.

Are there clinical trials studying social anxiety disorder?

NIMH supports a wide range of research, including clinical trials that look at new ways to prevent, detect, or treat diseases and conditions-including social anxiety disorder. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Researchers at NIMH and around the country conduct clinical trials with patients and healthy volunteers. Talk to a health care provider about clinical trials, their benefits and risks, and whether one is right for you. For more information, visit NIMH's clinical trials webpage.

Finding Help

Behavioral Health Treatment Services Locator

This online resource, provided by the Substance Abuse and Mental Health Services Administration (SAMHSA), helps you locate mental health treatment facilities and programs. Find a facility in your state by searching SAMHSA's online Behavioral Health Treatment Services Locator . For additional resources, visit NIMH's Help for Mental Illnesses webpage.

Talking to a Health Care Provider About Your Mental Health

Communicating well with a health care provider can improve your care and help you both make good choices about your health. Find tips to help prepare for and get the most out of your visit at Taking Control of Your Mental Health: Tips for Talking With Your Health Care Provider. For additional resources, including questions to ask a provider, visit the Agency for Healthcare Research and Quality website .

If you or someone you know is in immediate distress or is thinking about hurting themselves,call the National Suicide Prevention Lifeline toll-free at 1-800-273-TALK (8255). You also can text the Crisis Text Line (HELLO to 741741) or use the Lifeline Chat on the National Suicide Prevention Lifeline website .

Reprints

The information in this publication is in the public domain and may be reused or copied without permission. However, you may not reuse or copy the images. Please cite the National Institute of Mental Health as the source. Read our copyright policy to learn more about our guidelines for reusing NIMH content.

For More Information

MedlinePlus (National Library of Medicine) ( en español )

ClinicalTrials.gov ( en español )

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. 22-MH-8083
Revised 2022

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Social Anxiety Disorder: More Than Just Shyness

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Information about social anxiety disorder, including common signs and symptoms, treatment options, and how to find help.

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This page contains affiliate links, read the disclosure statement Inside: Kid tested strategies used by child therapists for calming anxiety, including ideas to calm down, books to read and videos that can help
It's happening again. Your daughter is frustrated and stomping away down to her room, slamming the door and in general "has her cranky pants on". You say calm down, but she yells back "I don't know how to do that!!!"

We tend to tell our kids to "calm down" without ever giving them explicit directions on how to deal with stress and anxiety. Here's a collection of the best tools and tips I've found to teach children how to calm down and relax.

Sometimes you'll need a quick way to help your child calm down and you don't have much with you. Maybe it's when you're out at Target or stuck in traffic. These tips will come in handy at those times:

Imagine your favorite place - it's like taking a mini vacation wherever you are

Think of your favorite things

Name animals alphabetically (alligator, bear, cow, dog, etc...)

Squeeze Something (play dough, clay, silly putty, your fists, a stress ball)

Get a Cold Drink of Water

54321 Grounding - go through each of your 5 senses

1. Put your arms straight out in front of you, palms facing out.

2. Put one hand over the other at the wrists and interlace your fingers.

3. Swoop your hands and arms toward your body and then place your interlaced hands on your chest.

4. Cross your feet at the ankles and put your tongue on the roof of your mouth.

5. Stay still for one minute.

It's great to have a big list of coping skills to try when your child needs to calm down. Here are two more short lists of ideas for calming down at home or at school.

From Imperfect Families - Strategies to use at home

From Encourage Play - 10 Strategies to Help Kids Calm Down at school or home

People usually roll their eyes initially when they hear "breathing is important". But I will continue to say it and explain why. It's so simple, yet has such a big impact on your body's physiology.

When you and calm and relaxed, your body is in "rest and digest" mode. You breathe normally, your heart rate is lower and your muscles are relaxed. However, when stress or anxiety or anger occurs, your body automatically switches into "flight, fight or freeze" mode. Your muscles tense up, your heart rate increases and your breathing becomes more shallow.

Taking deep breaths, instead of shallow breaths, is one way to tell your body to get back to resting and digesting. That's why deep breathing is important!

Luckily, there are some fun ways to teach kids deep breathing techniques

Things to use

Things to say

Breathe in like you are smelling a flower, breathe out like you are blowing out birthday candles

Arms up and breathe in, arms down and breathe out

Pretend your belly is a balloon. Breathe in and make the balloon bigger, then breathe out and make the balloon shrink.

Videos to watch
4 - 7 - 8 Breathing by GoZen
Breathing at Sea Otter Cove from Stress Free Kids

A Coping Skills Toolbox is a kit that you create to help your child calm down when they are upset, anxious or worried. In order to get the most benefit from this, you should create this kit before an issue occurs. When your child experiences anxiety, then they can pick out an item from their Coping Skills Toolbox. This is one of my favorite ways to help kids learn to calm their anxiety.

Here are some other fantastic ideas for what to put in a coping skills toolbox/calm down kit from And Next Comes L

You can create a place specially designed to allow to calm down in a few steps

Find a spot and make it cozy (ask your child for help with that - maybe they can place a favorite blanket or stuffed animal inside)

Add calming tools

Explain how to use it and practice before

When they are starting to escalate, catch it early and give them a calm reminder about their calm down spot

Use the following phrases as a way to support your child, let them know that you're going to support them and help them in any way that you can.

"I'm here for you"

"Talk to me and tell me what's going on"

"How can I help?"

"Together, we can work on this. We're a great team"

"I love you"

"Do you want a hug?"

Here are some more ideas of what to say to calm an anxious child.

From Go Zen - 49 Phrases to Calm an Anxious Child

From Lemon Lime Adventures - What to Say to Calm an Anxious Child

Did you know there are podcasts with stories for children? Usually the hosts have a soothing voice and the stories tend to be pretty short. Your child can listen to these podcasts as a way to have some down time.

There are scripts you can read to your child to help them relax and calm down. Slowly and carefully read the words as your child listens and follows the instructions. Check out Inner Health Studios list of scripts you can use with your child. If you prefer not to read a script, there are ones that are pre-recorded.

There are also scripts to practice mindfulness with children. Eline Snel has written a great book on Mindfulness with Kids, Sitting Still Like a Frog. Here are the several scripts that can be used from that book!

Annaka Harris also has several pre-recorded scripts to help kids practice mindfulness

Confused about how to introduce mindfulness to kids? Check out these resources:
Simple Ways to Introduce Mindfulness and Meditation to Children 11 Simple But Effective Ways to Teach Mindfulness to Kids
What you need:

I've used empty soda bottles, empty water bottles, glass jars and plastic containers. Use whatever makes sense for you and your family. For instance, for the calming jars the kids have in their room, I used a heavy duty plastic bottle. I didn't want them to accidentally knock over a glass jar in the dark - that would be a huge mess!

I've had the best results when I've used warm water - it makes it easier for the water and paint to combine.
Glitter Paint
I prefer using glitter paint (or glitter glue) instead of glitter because then I'm not cleaning up glitter for weeks at my house after we make them :-)

To make your jar, add glitter paint to the bottom of the jar until it just covers the bottom of it. Add warm water. Put the cover on and shake to help the ingredients combine. Once you are satisfied with the look of your jar, then you can super glue the lid shut so it doesn't spill. In a pinch, I've also used duct tape to secure the lid.
Watch Make a Simple Calming Jar from Coping Skills for Kids on YouTube Wet Ingredients
Sometimes you want the glitter/other items to stay afloat longer or for a shorter amount of time. Here are some different ingredients you can use as the wet ingredients.
Dry Ingredients
To see several other ways to make calming jars, take a look at what Preschool Inspirations did.

One of the first things I always like to do with kids if they are struggling is to start using visuals. When you're stressed and anxious, it's harder to read and take in information. Visuals are easier.

I like to keep calming cue cards in my children's coping skills toolboxes so that they can make a decision about what coping skill they can use. Sometimes pulling out a list is too much in the moment. You can make your own cue cards.

1. Take several index cards or small pieces of cardstock

2. On each one, write or draw one coping skill

3. Hole punch the cards and place them on a keyring (to make them extra sturdy, you can laminate them)

4. Put them into the coping skills toolbox for easy access

Using visuals is a powerful way to help kids. When kids are overwhelmed, sometimes it's hard for them to figure out what to do. By having cue cards, your child can have a visual reminder of what calms and relaxes them.

To make things a little easier, I've created ready to use coping skills cue cardsfor you. There are four different sets: Calming, Physical, Distracting, and Processing. If you'd like all 4, I created a set where you can download them all together.

If your child is anxious, they may also be having a difficult time getting settled for bedtime. Here are some ideas to help your child get settled at bedtime.

PINPOINT WHAT THE FEAR IS

One of the most important things to do is to figure out exactly what is causing the anxiety. Is it fear of the dark? Is it a worry about something in the closet? Is it monsters? Is it spiders? Figuring out the cause of the fear will help you come up with ways you can help your child combat it.

REARRANGE THE ROOM

Are there particular spots of the room that seem to be darker or cause more fear at night than others? Go into the bedroom during the day with your child and talk about the spots that make your child nervous. Try moving night lights and furniture around for a more calming room arrangement.

TRANSITIONAL OBJECTS

If your child has a hard time separating from you, try a transitional object. This is a special item that helps your child feel comforted. It helps them feel like part of you is still present even when you're not there. It could be something like a stuffed animal or a special stone or necklace, or a sweatshirt of yours. The object isn't what matters, it's what the object represents. They can keep it and hold it all night long to help them relax and go to sleep.

Find more strategies here: 12 Kid Friendly Strategies to Calm Anxiety at Night

Looking for some calming guided meditation to help get to sleep at night? Try one of these: Best Guided Meditations for Sleep.

Whenever I sit down and talk with someone about their coping skills, one of the first
things I ask is if they have tried writing about it. Why do I always start with journaling as
a way of processing through difficult feelings?

It's easier to write about than talk about hard things

Journaling helps you process what's happening.

It's convenient.

It's not graded

It can help you solve a problem

It can help you re-frame your thinking

Looking for a journal for a child or teen? Check out Big Life Journals!

General Anxiety

The Coping Skills for Kids Workbook by Janine Halloran. This book has over 75 strategies for kids to try to help them manage their stress and worry. This book also includes colorful worksheets to help kids learn more about their anxiety and what they can do to manage their stress.

Wilma Jean the Worry Machine by Julia Cook I love that when Wilma Jean's physical reactions are described, they're also illustrated. When is says she has knots in her stomach and her knees lock, her stomach really looks like it's tied in a knot and there's a real lock around her knees. I love the activity she does with her teacher, going over worries she can control and worries she can't, it's a great way to help kids manage their anxiety.

David and the Worry Beast by Anne Marie Guanci David's anxiety is a beast, and the more anxious he gets, the bigger it grows. David learns to control his thoughts, and his beast shrinks. There's also a couple of pages for parents and kids in the back.

When My Worries Get Too Big by Kari Dunn Buron This book is wonderful! There are several pages where kids can add in their own thoughts, worries and what helps them relax. This book also uses the 5 point scale to talk about stress and different ways to manage it.

What To Do When You Worry Too Much by Dawn Huebner, PhD This book goes through several ways that can help kids manage anxiety, including setting a time for worries, thinking about things that make you happy and resetting your body with activity or relaxation. There are some interactive places in this book, where a child can write down their worries, draw some images of things that might help, etc.

What To Do When You're Scared and Worried by James J. Crist This is one of my favorite books for kids to help them deal with anxiety. Near the beginning of the book is a checklist that helps kids narrow down what they are anxious about. The beginning of the book covers the basics of what anxiety is and how to help manage with coping skills. The next section of the book goes into detail about different types of anxiety kids might experience, including Separation Anxiety, Phobias and Panic Attacks.

Separation Anxiety

The Kissing Hand by Audrey Penn Classic about managing separation anxiety when kids start school. My daughter's kindergarten teacher read this on our visit to school the first day.

When I miss you by Cornelia Maude Spelman This is perfect for little ones who have a hard time dealing with the fact that they are away from their parents during the day. It suggests a couple of things they can do to help and reassurance that parents will come back at the end of the day.

Wemberley Worried by Kevin Henkes Poor Wemberley worries about everything, and then she gets really worried when she is about to start school.

This E-Course offers you instant support from a Child Therapist.
You will get:
12 Videos that are quick and bite size

14 Exercises that will expand on the skills taught

6 Cheat Sheets that will serve as a reference
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Access to the instructor for ongoing support

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More from Coping Skills for Kids about Anxiety in Children...

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Calming Anxiety - Coping Skills for Kids

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Inside: Kid tested strategies used by child therapists for calming anxiety, including ideas to calm down, books to read and videos that can help